Abstract: PD57-08
Sources of Funding: None

Introduction

Radical cystectomy for bladder cancer is a complex surgical oncology procedure. Accumulating data suggest variation in outcomes based on hospital and surgeon characteristics. Centralization of this procedure to high volume, fellowship-trained surgeons may improve clinical outcomes. High quality data examining the impact of radical cystectomy centralization are lacking. At the University of Alberta, radical cystectomy was centralized at a single institution and performed by 1 of 2 urologic oncologists starting in August 2013. Our objective was to compare outcomes of radical cystectomy before and after centralization of care._x000D_

Methods

A retrospective analysis of data from the University of Alberta Radical Cystectomy Database was performed. Eligible subjects were those with histologically proven urothelial carcinoma of the bladder (cTanyN1-3M0) undergoing curative intent surgery. Patients were classified into pre-centralization era (1994-2007; N=523) and post-centralization era (2013-present; N=134) cohorts for analyses. Pre-centralization era patients were treated by 1 of 11 urologic surgeons at 2 academic teaching hospitals. Post-centralization era patients were treated by 1 of 2 fellowship-trained urologic oncologists at 1 academic teaching hospital. Outcomes were overall survival, 90-day mortality rate, positive surgical margin (R1) resection rate, total number of lymph nodes evaluated, and 90-day blood product transfusion rate. The Kaplan-Meier method and multivariable regression analyses were used to analyze survival outcomes. Statistical tests were two-sided (p≤0.05)._x000D_ _x000D_

Results

The median follow-up duration in the pre- and post-centralization era was 33 months and 16 months, respectively. The predicted 2-year overall survival rate was 62% in the pre-centralization era and 84% in the post-centralization era (Log rank P=0.0007; multivariable HR 0.40, 95% CI 0.24 to 0.68, P<0.0001). Treatment in the post-centralization era was associated with lower 90-day mortality (6.3% versus 1.5%, multivariable OR 0.23, 95% CI 0.06 to 0.99, P=0.049), R1 resection (13.0% versus 1.5%; multivariable OR 0.07, 95% CI 0.01 to 0.51, P=0.009), and 90-day blood product transfusion (59% versus 6%, P<0.0001) as well as higher total number of lymph nodes evaluated (7 versus 30 lymph nodes, P<0.0001)._x000D_

Conclusions

Surgical treatment in the post-centralization era was associated with superior survival, cancer control, and perioperative outcomes._x000D_ _x000D_

Funding

None