Changing patterns of radical cystectomy at St.Vincent's Hospital, Melbourne

Purpose: To collect clinical, pathological and outcome data on all patients who have undergone radical cystectomy at St. Vincent's between 1985 and 2005.Methodology: A retrospective chart review was performed of all patients who had undergone cystectomy (patients identified using ICD codes). Detailed information was obtained from operation reports and inpatient notes. Further information was obtained from other treating hospitals and private rooms. Outcome data was checked against the Cancer Council of Victoria Deaths Registry. This series was then compared against other large published series, including a St. Vincent's Hospital cohort (1963–1977).Results: One hundred and seventeen patients underwent total cystectomy during this 20 year period. The main indication for radical cystectomy was muscle‐invasive transitional cell carcinoma (TCC), with 55% of patients having T3 or T4 disease. Only 12% of patients had node positive disease, which is a reflection of the selective use of pelvic lymphadenectomy (56% patients Nx). Median follow up of cancer survivors was 71 months (6.5–132). 30% of patients had a history of superficial TCC. The postoperative mortality rate (occurring within 60 days or before discharge) was 6%. Only 14% patients had adjuvant chemotherapy. 57% of patients developed a recurrence with an overall five‐year survival of 38%.Conclusion: In comparison to North American and European series, our five‐year survival is lower but a higher proportion of patients have muscle‐invasive (T2–T4) disease. Postoperative mortality rates are comparable to other institutions, and importantly, a 60% reduction in postoperative mortality has occurred at our institution over the last 40 years.