INTRODUCTION & OBJECTIVES: There is some evidence to suggest that the time interval between diagnosis of muscle-invasive bladder cancer and cystectomy may influence outcome. We determine whether “time to cystectomy” impacts on overall survival.

MATERIAL & METHODS: Data were extracted from the Hospital Episode Statistics (HES) database of admissions to NHS hospitals in England. Patients were identified if specific ICD-10 diagnosis and OPCS-4 codes, indicating cystectomy for malignant disease, were located in any of the diagnostic or operative fields of the HES database. The time interval between TURBT and cystectomy was calculated for each patient and then collapsed into 5 “time to cystectomy” categories. 0-2 weeks (n=99), 3-6 weeks (n=798), 7-10 weeks (n=997), 11-14 weeks (n=706) and >14 weeks (n=581). To calculate survival, HES patient records were linked to national mortality records. Kaplan Meier analysis and Cox proportional hazard models were used to assess significance. 3,161 patients were included in the study. Mean follow up was 860 days.

RESULTS: Mean age at time of cystectomy was 66.4 years, 2,418 (76%) were male and 1,659 (52%) had co-morbid disease. Mean “time to cystectomy” was 71.5 days. “Time to cystectomy” was found to be significantly higher in older patients (78.0 days versus 63.4 days, p<0.001), men (73.3 days versus 65.5 days, p<0.001) and those patients with co-morbid disease (74.2 days versus 68.4 days, p = 0.015). Mean 1-year and 2-year overall survival after cystectomy was 76.3% and 65.2% respectively.

Increasing “time to cystectomy” was not found to be associated with a worse overall survival (p=0.375), length of stay (p=0.168, coefficient =0.09) or in-hospital death (p=0.398, coefficient = 4.19).

CONCLUSIONS: This study suggests that, although early cystectomy for muscle-invasive bladder cancer is advantageous, a short delay, for example, for the seeking of alternative medical opinions or the scheduling of surgery, is unlikely to result in worse survival.