Should all cystectomies be centralised?-a retrospective study of perioperative and pathological outcomes of radical cystectomy in a regional Australian centre.
5 affiliations
- 1Department of Surgery, Wagga Wagga Base Hospital, Wagga Wagga, NSW, Australia.
- 2University of New South Wales Rural Medical School, Wagga Wagga, NSW, Australia.
- 3St Vincent's Private Hospital, Sydney, NSW, Australia.
- 4Calvary Riverina Private Hospital, Wagga Wagga, NSW, Australia.
- 5St Vincent's Private Hospital, Griffith, NSW, Australia.
Abstract
Radical cystectomy is a complex oncological procedure associated with significant morbidity. Centralisation of radical cystectomy in Australia to tertiary centres, usually in metropolitan areas, is postulated to both reduce operative complications and improve oncological outcomes. However, long distance travel for treatment away from social supports is a significant barrier for many regional and rural patients. We evaluate perioperative and pathological outcomes of radical cystectomy performed in the rural Australian city of Wagga Wagga to determine the actual safety of performing radical cystectomy in lower volume centres and evaluate indications for referral to tertiary centres. A retrospective cohort study was conducted of patients undergoing open radical cystectomy or anterior pelvic exenteration with ileal conduit diversion at Wagga Wagga Base Hospital between January 2015 and December 2024. Perioperative and pathological outcomes were analysed and compared with published national and international benchmarks. A retrospective audit of patients referred to tertiary centres during the study period assessed the rationale for referrals. Seventeen patients underwent open radical cystectomy or anterior pelvic exenteration and ileal conduit during the audit period. Eleven (65%) cases were assisted by a second FRACS urologist or general surgeon. The mean age of patients was 70 years. Eight (47%) cases were pathological stage pTa/T1, four (24%) were pT2, and five (29%) were pT3. The mean lymph node yield was n=10 per patient. The positive surgical margin rate was 17.6% (n=3) (6% T2 and 12% T3). The overall 30-day postoperative Clavien-Dindo (CD) complication rate was 65% (n=11) (12% CD I, 35% CD II, 6% CD IIIa, 6% CD IIIb, 0% CD IV, 5% CD V). The CD IIIa complication was a wound dehiscence requiring antibiotics and closure under local anaesthetic. The CD IIIb complication was a small bowel obstruction managed with laparotomy and division of adhesions. The CD V complication was obstructive shock secondary to pulmonary emboli and heparin-induced thrombocytopaenia. These data are comparable to open cystectomy outcomes in national and international centres. Eleven patients were referred to tertiary centres for cystectomy during the audit period. The rationale for referral was consideration for neobladder (n=6) or case complexity secondary to prior pelvic radiation (n=3) or variant pathology (n=2). With appropriate case selection, performance of open radical cystectomy and anterior pelvic exenteration with ileal conduit diversion in regional Australia by experienced pelvic surgeons is feasible in carefully selected patients. Shared decision-making should include counselling of positive margins and complications locally and at the tertiary referral site to inform decisions regarding location of care. These findings support the feasibility and safety of delivering complex oncological surgery in appropriately resourced regional centres.
Related
- Preoperative ovarian vascular parameters and perioperative factors associated with ovarian reserve marker decline after laparoscopic endometrioma cystectomy: a retrospective prediction study
- Does Timing Matter? Perioperative Outcomes and Quality of Life After Early Versus Delayed Radical Cystectomy Following BCG Therapy
- Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Perioperative Management and Operative Technique
- Perioperative outcomes of intracorporeal versus extracorporeal urinary diversion following robot-assisted radical cystectomy in multicenter KORARC database
- Cytoreductive cystectomy combined with chemotherapy versus chemotherapy alone in the treatment of metastatic bladder cancer: A retrospective comparative study.
BibTeX
@article{williams2026should,
title = {{Should all cystectomies be centralised?-a retrospective study of perioperative and pathological outcomes of radical cystectomy in a regional Australian centre.}},
author = {Zoe Williams and Bhavya Gupta and Allyson Tai and James Symons and Paul Bergamin and Steven Sowter},
journal = {Translational andrology and urology},
year = {2026},
month = oct,
doi = {10.21037/tau-2026-1-0132},
url = {https://europepmc.org/article/MED/42997236},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Should all cystectomies be centralised?-a retrospective study of perioperative and pathological outcomes of radical cystectomy in a regional Australian centre.
AU - Zoe Williams
AU - Bhavya Gupta
AU - Allyson Tai
AU - James Symons
AU - Paul Bergamin
AU - Steven Sowter
PY - 2026
DA - 2026/10/19
JO - Translational andrology and urology
DO - 10.21037/tau-2026-1-0132
UR - https://europepmc.org/article/MED/42997236
AB - Radical cystectomy is a complex oncological procedure associated with significant morbidity. Centralisation of radical cystectomy in Australia to tertiary centres, usually in metropolitan areas, is postulated to both reduce operative complications and improve oncological outcomes. However, long distance travel for treatment away from social supports is a significant barrier for many regional and rural patients. We evaluate perioperative and pathological outcomes of radical cystectomy performed in the rural Australian city of Wagga Wagga to determine the actual safety of performing radical cystectomy in lower volume centres and evaluate indications for referral to tertiary centres. A retrospective cohort study was conducted of patients undergoing open radical cystectomy or anterior pelvic exenteration with ileal conduit diversion at Wagga Wagga Base Hospital between January 2015 and December 2024. Perioperative and pathological outcomes were analysed and compared with published national and international benchmarks. A retrospective audit of patients referred to tertiary centres during the study period assessed the rationale for referrals. Seventeen patients underwent open radical cystectomy or anterior pelvic exenteration and ileal conduit during the audit period. Eleven (65%) cases were assisted by a second FRACS urologist or general surgeon. The mean age of patients was 70 years. Eight (47%) cases were pathological stage pTa/T1, four (24%) were pT2, and five (29%) were pT3. The mean lymph node yield was n=10 per patient. The positive surgical margin rate was 17.6% (n=3) (6% T2 and 12% T3). The overall 30-day postoperative Clavien-Dindo (CD) complication rate was 65% (n=11) (12% CD I, 35% CD II, 6% CD IIIa, 6% CD IIIb, 0% CD IV, 5% CD V). The CD IIIa complication was a wound dehiscence requiring antibiotics and closure under local anaesthetic. The CD IIIb complication was a small bowel obstruction managed with laparotomy and division of adhesions. The CD V complication was obstructive shock secondary to pulmonary emboli and heparin-induced thrombocytopaenia. These data are comparable to open cystectomy outcomes in national and international centres. Eleven patients were referred to tertiary centres for cystectomy during the audit period. The rationale for referral was consideration for neobladder (n=6) or case complexity secondary to prior pelvic radiation (n=3) or variant pathology (n=2). With appropriate case selection, performance of open radical cystectomy and anterior pelvic exenteration with ileal conduit diversion in regional Australia by experienced pelvic surgeons is feasible in carefully selected patients. Shared decision-making should include counselling of positive margins and complications locally and at the tertiary referral site to inform decisions regarding location of care. These findings support the feasibility and safety of delivering complex oncological surgery in appropriately resourced regional centres.
SN - 2223-4691
ER -