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

Harman M. Bruins, Erik Veskimäe, Virginia Hernández, Yann Neuzillet, Richard Cathomas, Eva M. Compérat, Nigel C. Cowan, Georgios Gakis, Estefania Linares Espinós, Anja Lorch, Maria J. Ribal, Mathieu Rouanne, George N. Thalmann, Yuhong Yuan, Antoine G.van der Heijden, J. Alfred Witjes

    Research output: Contribution to journalReview Articlepeer-review

    18 Citations (Scopus)

    Abstract

    CONTEXT: In bladder cancer patients treated with radical cystectomy (RC), controversy exists regarding the impact of the annual hospital volume (HV) and/or surgeon volume (SV) on oncological outcomes and quality of care. OBJECTIVE: A systematic review was performed to evaluate the impact of HV and SV on clinical outcomes. Primary outcomes included in-hospital, 30-d, and 90-d mortality. Secondary outcomes included complications, long-term survival, positive surgical margin rate, lymphadenectomy performance, length of hospital stay, neobladder performance, and blood loss/transfusion rate. EVIDENCE ACQUISITION: Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched. Comparative studies published after the year of 2000 including patients who underwent RC for bladder cancer were eligible for inclusion. Partial cystectomy was an exclusion criterion. Risk of bias (RoB) assessment was performed according to the ROBINS-1 tool. EVIDENCE SYNTHESIS: After screening of 1190 abstracts, 39 studies recruiting 549 542 patients were included. All studies were retrospective observation cohort studies (level of evidence 3). Twenty-two studies reported on HV only, six studies on SV only, and 12 on both. Higher HV, specifically an HV of >10, was associated with improved primary and secondary outcomes in most studies. In addition, there is some evidence that an HV of >20 improves outcomes. For SV, limited and conflicting data are reported. Most studies had moderate to high RoB. The results were synthesized narratively. CONCLUSIONS: Acknowledging the lower level of evidence, HV is likely associated with in-hospital, 30- and 90-d mortality, as well as the secondary outcomes assessed. Based on this study, the European Association of Urology Muscle-invasive and Metastatic Bladder Cancer Guideline Panel recommends hospitals to perform at least 10, and preferably >20, RCs annually or refer the patient to a center that reaches this number. For SV, limited and conflicting data are available. The available evidence suggests HV rather than SV to be the main driver of perioperative outcomes. PATIENT SUMMARY: Current literature suggests that the number of bladder removal operations per hospital per year is associated with postoperative survival as well as the quality of care provided.

    Original languageEnglish
    Pages (from-to)131-144
    Number of pages14
    JournalEuropean Urology Oncology
    Volume3
    Issue number2
    DOIs
    Publication statusPublished - 2020
    Publication typeA2 Review article in a scientific journal

    Keywords

    • Bladder cancer
    • Hospital volume
    • Oncological outcomes
    • Radical cystectomy
    • Surgeon volume

    Publication forum classification

    • Publication forum level 1

    ASJC Scopus subject areas

    • Surgery
    • Oncology
    • Radiology Nuclear Medicine and imaging
    • Urology

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