Outcomes following open radical cystectomy: an 11-year Christchurch experience

Radical cystectomy (RC) remains the standard approach to treating muscle invasive bladder cancer. Despite improvements in surgical and anaesthetic care, morbidity and mortality remain high. In the United Kingdom, centralisation has improved outcomes following RC. However, in New Zealand no centralisation or mandatory reporting of outcomes exists.

A retrospective review of all patients who underwent RC at Christchurch Hospital, New Zealand, between January 2007 and January 2018 was undertaken. Data on demographic, opera-tive and post-operative variables were collected. Thirty- and 90-day mortality rates were assessed along with five-year survival. Multivariate logistic regression was used to assess factors associated with survival.

During the 11-year period, 135 patients underwent RC. There were low rates of neo-adjuvant (11%) and adjuvant (5%) chemotherapy use. The median length of stay was 10 days (6-44 days) and 23 patients (17%) had a Clavien-Dindo grade 3 or above complication. Thirty- and 90-day mortality was 2.2% and 4.4% respectively. Five-year overall and disease-specific survival rates were 49.7% and 59.3% respectively. American Joint Committee on Cancer (AJCC) stage was a positive predictor of overall survival, with the risk of death increasing incrementally for each progression of stage. Age, sex and comorbidity status were not significant predictors of either overall or disease-specific survival.

Our study is the first to report radical cystectomy outcomes in New Zealand. Alt-hough the perioperative outcomes were comparable to other published series, the subsequent development of metastatic disease remains a problem, with poor five-year survival rates.