Trends in operative caseload and mortality rates after radical cystectomy for bladder cancer in England for 1998-2010.
Eur Urol
; 67(6): 1056-1062, 2015 Jun.
Article
em En
| MEDLINE
| ID: mdl-25530608
ABSTRACT
BACKGROUND:
The Improving Outcomes in Urological Cancers guidelines recommended centralisation of cystectomy services to improve outcomes for bladder cancer (BCa) patients.OBJECTIVE:
To investigate trends in all-cause and cause-specific survival to see if there was an improvement in survival after centralisation was implemented. To analyse trends in the number of acute hospital trusts undertaking cystectomy. DESIGN, SETTING, ANDPARTICIPANTS:
We used routine data to capture information on radical cystectomy (RC) in BCa patients aged 20 yr and older between 1998 and 2010 (n=16,033). OUTCOME MEASUREMENTS AND STATISTICALANALYSIS:
We calculated 30-d and 90-d mortality, and 30-d, 90-d, 1-yr, and 5-yr survival. The average number of RCs per trust was derived. Trends were identified using regression analysis. RESULTS ANDLIMITATIONS:
The 30-d crude mortality decreased from 5.2% to 2.1% (p<0.001) and 90-d crude mortality decreased from 10.3% to 5.1% (p<0.001). There was an increase in 30-d relative survival from 96% to 98% (p<0.001), in 90-d relative survival from 91% to 96% (p<0.001), in 1-yr relative survival from 71% to 80% (p<0.001), and in 5-yr relative survival from 49% to 56% (2004-2006 data; p<0.001). The mean number of RCs performed by trusts in England increased from six to 24 (p<0.001). Smoking status and stage at diagnosis were not available.CONCLUSIONS:
Survival after RC has increased alongside decreases in short-term mortality. There is little evidence of a cohort effect. The trends in survival are linear and we conclude that the continued survival improvements are a result of a combination of service improvements that include service reconfiguration, improved surgical training, neoadjuvant chemotherapy, enhanced recovery principles, and continued improvements in perioperative care. PATIENTSUMMARY:
We analysed routinely collected hospital data. Outcomes for patients who undergo cystectomy have improved for all age groups. This is likely to be due to a combination of changes in practice.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Bexiga Urinária
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Neoplasias da Bexiga Urinária
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Cistectomia
Tipo de estudo:
Etiology_studies
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Guideline
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article