1762 REGIONAL DIFFERENCES IN PRACTICE PATTERNS AND OUTCOMES AFTER RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 20121762 REGIONAL DIFFERENCES IN PRACTICE PATTERNS AND OUTCOMES AFTER RADICAL CYSTECTOMY Bassel G. Bachir, Faysal A. Yafi, Armen Aprikian, Joseph L. Chin, Jonathan Izawa, Yves Fradet, Louis Lacombe, Darrel Drachenberg, Eric Estey, Adrian Fairey, Ricardo Rendon, David Bell, Jean-Baptiste Lattouf, Ilias Cagiannos, and Wassim Kassouf Bassel G. BachirBassel G. Bachir Montreal, Canada More articles by this author , Faysal A. YafiFaysal A. Yafi Montreal, Canada More articles by this author , Armen AprikianArmen Aprikian Montreal, Canada More articles by this author , Joseph L. ChinJoseph L. Chin London, Canada More articles by this author , Jonathan IzawaJonathan Izawa London, Canada More articles by this author , Yves FradetYves Fradet Laval, Canada More articles by this author , Louis LacombeLouis Lacombe Laval, Canada More articles by this author , Darrel DrachenbergDarrel Drachenberg winnipeg, Canada More articles by this author , Eric EsteyEric Estey Edmonton, Canada More articles by this author , Adrian FaireyAdrian Fairey Edmonton, Canada More articles by this author , Ricardo RendonRicardo Rendon Halifax, Canada More articles by this author , David BellDavid Bell Halifax, Canada More articles by this author , Jean-Baptiste LattoufJean-Baptiste Lattouf Montreal, Canada More articles by this author , Ilias CagiannosIlias Cagiannos Ottowa, Canada More articles by this author , and Wassim KassoufWassim Kassouf Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1778AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess differences in practice patterns and outcomes across three separate regions in a universal health care system in patients who had undergone radical cystectomy. METHODS This multi-institutional series included 2287 patients who had undergone radical cystectomy at eight Canadian centers from 1998 until 2008. Collected variables included various clinical and pathological parameters, recurrence, and death stratified into three sets to account for the different regions (east, center, west). RESULTS Of 2287 patients, there were 1105 patients from eastern (group 1, 49%), 601 patients from central (group 2, 26%), and 581 from western Canada (group 3, 25%). The median follow-up of group 1, 2 and 3 was 22.1, 17.1, and 28.6 months respectively. There were no differences among the three geographical locations in terms of pathologic stage, rate of surgical margin positivity, adjuvant chemotherapy and smoking status. Rates of neoadjuvant chemotherapy were higher in group 2 compared with group 1 and 3 (p=0.07). There were statistically significant differences in clinicopathological parameters across the 3 groups, specifically gender distribution, performance of a lymphadenectomy, type of diversion and rates of concomitant cis, and lymphovascular invasion. The mean number of days to cystectomy from last TURBT was 50 vs. 79 vs. 69 days for groups 1, 2 and 3 respectively (p=0.0006). On Kaplan-Meier survival analysis, there was a statistically significant difference (p<0.0001) in overall survival (53.6% vs. 66.8% vs. 52.4% for groups 1, 2 and 3). CONCLUSIONS Significant variations in practice patterns were noted across different geographic regions in a universal health care system. The use of orthotopic bladder substitutes remains low across all 3 regions. Treatment delays are prolonged across Canada with significant regional variations. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e711 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bassel G. Bachir Montreal, Canada More articles by this author Faysal A. Yafi Montreal, Canada More articles by this author Armen Aprikian Montreal, Canada More articles by this author Joseph L. Chin London, Canada More articles by this author Jonathan Izawa London, Canada More articles by this author Yves Fradet Laval, Canada More articles by this author Louis Lacombe Laval, Canada More articles by this author Darrel Drachenberg winnipeg, Canada More articles by this author Eric Estey Edmonton, Canada More articles by this author Adrian Fairey Edmonton, Canada More articles by this author Ricardo Rendon Halifax, Canada More articles by this author David Bell Halifax, Canada More articles by this author Jean-Baptiste Lattouf Montreal, Canada More articles by this author Ilias Cagiannos Ottowa, Canada More articles by this author Wassim Kassouf Montreal, Canada More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...