Should all cystectomies be centralised?—a retrospective study of perioperative and pathological outcomes of radical cystectomy in a regional Australian centre
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: 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. Methods: 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. Results: 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). Conclusions: 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.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223970278