Cystectomy for bladder cancer in Sweden – short-term outcomes after centralization

Authors

  • Fredrik Liedberg Department of Urology Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Oskar Hagberg Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Firas Aljabery Department of Clinical and Experimental Medicine, Division of Urology, Linköping, University, Linköping, Sweden
  • Ove Andrén Section of Urology, Department of Surgery, Skellefteå Hospital, Sweden
  • Victor Falini Regional Cancercenter South, Lund, Sweden
  • Truls Gårdmark Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
  • Viveka Ströck Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
  • Tomas Jerlström Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

DOI:

https://doi.org/10.2340/sju.v59.40120

Keywords:

bladder cancer, radical cystectomy, centralization, hospital volume

Abstract

Objective: Radical cystectomy (RC) for bladder cancer is associated with an inherent risk of complications and even postoperative mortality. The number of hospitals performing RC has decreased in Sweden over time, and since a formal regional centralization in 2017 cystectomy care is currently provided by nine hospitals.

Material and methods: In the Swedish National Urinary Bladder Cancer Register (SNRUBC) 90-day complications after RC have been registered with high coverage since 2012. Descriptive data and short-term outcomes were compared in relation to centralization of the cystectomy care by stratifying data before (2012–2016) and after (2017–2023).

Results: Out of all 4,638 cystectomies, 2,738 (59%) were performed after the centralization in 2017 and onwards. The median age at RC increased from 71 (Inter Quartile Range [IQR] 65–76) to 73 (IQR 67–77) years, and the proportion of patients with comorbidity (American Society of Anesthesiologists [ASA] 3 or 4) increased from 32% to 37% after the centralization (p < 0.001). The number of patients suffering from high-grade complications within 90 days of surgery corresponding to Clavien grade three were 345 (18%) and 407 (15%), and corresponding to Clavien grade four 61 (3%) and 64 (2%) before and after centralization, respectively. Reoperations within 90 days of RC decreased from 234/1,900 (12%) to 208/2,738 (8%) (p < 0.001), and 90-day mortality decreased from 84/1,900 (4%) to 85/2,738 (3%) (p = 0.023) before and after centralization, respectively.

Conclusion: After the centralization of the cystectomy-care in Sweden, older patients and individuals with more extensive comorbidity were offered RC whereas 90-day mortality and the proportion of patients subjected to reoperations within 90 days of surgery decreased without increasing waiting times.

Downloads

Download data is not yet available.

References

Klemm J, Fisch M, Laukhtina E, et al. Continent diversion is losing its momentum: a nationwide trend analysis from Germany 2005–2021. BJU Int. 2023.

https://doi.org/10.1111/bju.16215 DOI: https://doi.org/10.1111/bju.16215

Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979;301:1364–1369.

https://doi.org/10.1056/NEJM197912203012503 DOI: https://doi.org/10.1056/NEJM197912203012503

Bruins HM, Veskimäe E, Hernández V, et al. The importance of hospital and surgeon volume as major determinants of morbidity and mortality after radical cystectomy for bladder cancer: a systematic review and recommendations by the European Association of Urology muscle-invasive and metastatic bladder cancer guideline panel. Eur Urol Oncol. 2020;3:131–144.

https://doi.org/10.1016/j.euo.2019.11.005 DOI: https://doi.org/10.1016/j.euo.2019.11.005

Liedberg F, Hagberg O, Aljabery F, et al. Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care: a nationwide population-based study. BJU Int. 2019;124:449–456.

https://doi.org/10.1111/bju.14767 DOI: https://doi.org/10.1111/bju.14767

https://cancercentrum.se/globalassets/vara-uppdrag/nivastrukturering/remisser-och-beslutsunderlag/omgang-3/beslutsrekommendation_till_landsting-regioner_161212.pdf

https://statistik.incanet.se/Urinblasecancer/

Liedberg F, Kjellström S, Lind AK, et al. Swedish National Guidelines on Urothelial Carcinoma: 2021 update on non-muscle invasive bladder cancer and upper tract urothelial carcinoma. Scand J Urol. 2022;56:137–146.

https://doi.org/10.1080/21681805.2022.2041086 DOI: https://doi.org/10.1080/21681805.2022.2041086

Abuhasanein S, Jahnson S, Aljabery F, et al. Standardized care pathways for patients with suspected urinary bladder cancer: the Swedish experience. Scand J Urol. 2022;56:227-232.

https://doi.org/10.1080/21681805.2022.2058605 DOI: https://doi.org/10.1080/21681805.2022.2058605

Lind AK, Liedberg F, Aljabery F, et al. Health-related quality of life prior to and 1 year after radical cystectomy evaluated with FACT-G and FACT-VCI questionnaires. Scand J Urol. 2023;58:76–83.

https://doi.org/10.2340/sju.v58.11952 DOI: https://doi.org/10.2340/sju.v58.11952

Anell A, Hagberg O, Liedberg F, et al. A randomized comparison between league tables and funnel plots to inform health care decision-making. Int J Qual Health Care. 2016;28:816–823.

https://doi.org/10.1093/intqhc/mzw125 DOI: https://doi.org/10.1093/intqhc/mzw125

Häggström C, Hagberg O, Gårdmark T, et al. Cohort profile: Bladder Cancer Data Base Sweden (BladderBaSe) 2.0. BMJ Open. 2022;12:e064898.

https://doi.org/10.1136/bmjopen-2022-064898 DOI: https://doi.org/10.1136/bmjopen-2022-064898

Böös M, Jerlström T, Beckman E, et al. Who should record surgical complications? Results from a third-party assessment of complications after radical cystectomy. Scand J Urol. 2019;53:339–343.

https://doi.org/10.1080/21681805.2019.1643912 DOI: https://doi.org/10.1080/21681805.2019.1643912

Hounsome LS, Verne J, McGrath JS, et al. Trends in operative caseload and mortality rates after radical cystectomy for bladder cancer in England for 1998–2010. Eur Urol. 2015;67:1056–1062.

https://doi.org/10.1016/j.eururo.2014.12.002 DOI: https://doi.org/10.1016/j.eururo.2014.12.002

Björnsson O, Gudmundsson EO, Marteinsson VT, et al. Radical cystectomy in the treatment of bladder cancer in Iceland: a population-based study. Scand J Urol. 2016;50:65–70.

https://doi.org/10.3109/21681805.2015.1085088 DOI: https://doi.org/10.3109/21681805.2015.1085088

Maibom SL, Joensen UN, Poulsen AM, et al. Short-term morbidity and mortality following radical cystectomy: a systematic review. BMJ Open. 2021;11:e043266.

https://doi.org/10.1136/bmjopen-2020-043266 DOI: https://doi.org/10.1136/bmjopen-2020-043266

Richters A, Ripping TM, Kiemeney LA, et al. Hospital volume is associated with postoperative mortality after radical cystectomy for treatment of bladder cancer. BJU Int. 2021;128:511–518.

https://doi.org/10.1111/bju.15334 DOI: https://doi.org/10.1111/bju.15334

Motlagh SR, Mori K, Aydh A, et al. Impact of hospital and surgeon volumes on short-term and long-term outcomes of radical cystectomy. Curr Opin Urol. 2020;30:701–710.

https://doi.org/10.1097/MOU.0000000000000805 DOI: https://doi.org/10.1097/MOU.0000000000000805

Wuethrich PY, Burkhard FC, Thalmann GN, et al. Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial. Anesthesiology. 2014;120:365–377.

https://doi.org/10.1097/ALN.0b013e3182a44440

Zhou Y, Li R, Liu Z, et al. The effect of the enhanced recovery after surgery program on radical cystectomy: a meta-analysis and systematic review. Front Surg. 2023;10:1101098. DOI: https://doi.org/10.3389/fsurg.2023.1101098

https://doi.org/10.1097/ALN.0b013e3182a44440 DOI: https://doi.org/10.1097/ALN.0b013e3182a44440

Vrang ML, Østergren PB, Fode MM, et al. Robot-assisted radical cystectomy with intracorporeal urinary diversion: a Danish 11-year series. BJU Int. 2023;132:428–434.

https://doi.org/10.1111/bju.16098 DOI: https://doi.org/10.1111/bju.16098

Katsimperis S, Tzelves L, Tandogdu Z, et al. Complications after radical cystectomy: a systematic review and meta-analysis of randomized controlled trials with a meta-regression analysis. Eur Urol Focus. 2023;9(6):920–929.

https://doi.org/10.1016/j.euf.2023.05.002 DOI: https://doi.org/10.1016/j.euf.2023.05.002

Russell B, Liedberg F, Khan MS, et al. A systematic review and meta-analysis of delay in radical cystectomy and the effect on survival in bladder cancer patients. Eur Urol Oncol. 2020;3:239–249.

https://doi.org/10.1016/j.euo.2019.09.008 DOI: https://doi.org/10.1016/j.euo.2019.09.008

Liedberg F, Hagberg O, Aljabery F, et al. Survival after radical cystectomy during holiday periods. Scand J Urol. 2021;55:276–280.

https://doi.org/10.1080/21681805.2021.1938665 DOI: https://doi.org/10.1080/21681805.2021.1938665

Bergengren O, Belozerov A, Bill-Axelson A, et al. Short term outcomes after robot assisted and open cystectomy – a nation-wide population-based study. Eur J Surg Oncol. 2023;49:868–874.

https://doi.org/10.1016/j.ejso.2023.01.023 DOI: https://doi.org/10.1016/j.ejso.2023.01.023

Dixon S, Hill H, Flight L, et al. Cost-effectiveness of robot-assisted radical cystectomy vs open radical cystectomy for patients with bladder cancer. JAMA Netw Open. 2023;6:e2317255.

https://doi.org/10.1001/jamanetworkopen.2023.17255 DOI: https://doi.org/10.1001/jamanetworkopen.2023.17255

Leow JJ, Cole AP, Seisen T, et al. Variations in the costs of radical cystectomy for bladder cancer in the USA. Eur Urol. 2018;73:374–382.

https://doi.org/10.1016/j.eururo.2017.07.016 DOI: https://doi.org/10.1016/j.eururo.2017.07.016

Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491–499.

https://doi.org/10.1056/NEJMsa0810119 DOI: https://doi.org/10.1056/NEJMsa0810119

Downloads

Published

2024-04-29

How to Cite

Liedberg, F., Hagberg, O., Aljabery, F., Andrén, O., Falini, V., Gårdmark, T., Ströck, V., & Jerlström, T. (2024). Cystectomy for bladder cancer in Sweden – short-term outcomes after centralization. Scandinavian Journal of Urology, 59, 84–89. https://doi.org/10.2340/sju.v59.40120

Issue

Vol. 59 (2024)

Section

Original research article

License

Copyright (c) 2024 Fredrik Liedberg, Oskar Hagberg, Firas Aljabery, Ove Andrén, Victor Falini, Truls Gårdmark, Viveka Ströck, Tomas Jerlström

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.

Crossref
Scopus
Google Scholar
Europe PMC

Funding data