AUA 2017: Centralization of Radical Cystectomy for Bladder Cancer in a Universal Healthcare System: Early Results from a Canadian Academic Center
Boston, MA (UroToday.com) Dr. Krzysztof and colleagues looked at the clinical outcomes in patients who underwent radical cystectomy in the Canadian system. The Canadian system is unique because they have purposefully centralized radical cystectomy to high volume and fellowship trained surgeons. The objective of this study was to determine if there was a difference in the outcomes of radical cystectomy before and after centralization of care. They performed a retrospective analysis with 523 patients after centralization and 124 after centralization. The predicted 2-year survival for patients undergoing radical cystectomy prior to centralization was 67% and 84% after centralization (p<0.001), yielding a HR of 0.40 (95%CI 0.24-0.68). The centralization was associated with decreased 90-day mortality (6.3% versus 1.5%, p=0.049) and decreased positive margins (13.0% versus 1.5%, p=0.009).
This study demonstrated two important points associated with centralization of radical cystectomy. Not only does centralization improve survival both acutely and at 2-years, there is also improved oncologic outcomes. In addition, the burden on the health system was handled adequately and with success in improving outcomes.
Presented By: Jan Krzysztof Rudzinski, BSc, MD
Written By: Janet Baack Kukreja (@janetkukreja), MD, MPH, Urologic Oncology Fellow, Department of Urology, UT MD Anderson Cancer Center, Houston, TX, Ashish M. Kamat, MD, MBBS, FACS, Wayne B. Duddlesten Professor, Department of Urology, UT MD Anderson Cancer Center, Houston TX
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA