| A delay in cystectomy may alter survival in patients with bladder cancer
A contemporary cohort of 214 consecutive patients presented with clinical T2 bladder cancer and underwent radical cystectomy as primary therapy. Clinicopathologic parameters were maintained in an institutional database. A review of time-to-cystectomy, pathologic stage, disease-specific survival (DSS), and overall survival (OS) was undertaken. A significant DSS and OS advantage was observed for those undergoing cystectomy * 93 days (3.1 months) compared to > 93 days (p=0.05 and p=0.02, respectively). Pathologic staging was similar between groups (p=0.15). A multivariate benefit in OS was observed for patients treated with timely cystectomy. The most common factor contributing to cystectomy delay was scheduling delay, seen in 46% of cases. We concluded that a cystectomy delay of 3.1 months undermines patient survival. This may relate to the development of micrometastases, as local tumor progression is not clearly evident at this time point. Most delays are avoidable and should be minimized. Despite the need for second opinions and the impact of busy surgical schedules, clinicians must strive for expedient referral, rigorous coordination of preoperative counseling and medical clearance, and detailed patient education to permit an efficient decision-making process and timely delivery of surgery.
Bibliographical reference:
Cheryl Lee Michigan Urology Center, University of Michigan, Ann Arbor, Michigan, USA
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