The use of bladder orthotopic reconstruction after cystectomy for cancer is uncommon in England and varies significantly among patient groups, report researchers.
In an analysis of 1756 patients who underwent cystectomy, they found that about one in 15 individuals subsequently had orthotopic reconstruction. This is much lower than rates observed in the USA or Europe.
Men and younger patients were significantly more likely to be treated with orthotopic reconstruction, as were more affluent patients and those with less advanced disease.
"Given evidential uncertainty about quality-of-life benefits of orthotopic reconstruction and the observed variation in its use, re-examining this question in a nationwide population-based context would be useful," remark Georgios Lyratzopoulos (University of Cambridge, UK) and colleagues.
The team linked information from the British Association of Urological Surgeons Cancer Registry Complex Operations dataset to Hospital Episode Statistics data covering the period 2004-2011. They found that only 120 (6.8%) bladder cancer patients were treated using orthotopic reconstruction after undergoing cystectomy.
As reported in BJU International, multivariate analysis revealed that women were a significant 2.3 times less likely to undergo the procedure than men.
The likelihood for the procedure also decreased sharply with age, by 63% for each 10-year increase between the age categories of 30-39 years and 70 years or more.
Socioeconomic analysis, using the income domain of the Indices of Deprivation 2007, showed that the likelihood of being treated with bladder reconstruction increased by 17% for each decreasing deprivation quintile. And each increase in cancer stage was also associated with a significant decrease in the likelihood of the procedure being used (20% per increase in stage).
Overall, 121 consultants performed the reconstruction procedure across 17 of the 29 cancer networks (organizations responsible for ensuring the quality of cancer services) in England.
The researchers report a significant variation among individual consultants in terms of surgery expertise. "This is an expected finding, given the degree of sub-specialization required for orthotopic reconstruction." After adjustment for the substantial variation between consultants, there was very limited variation in the use of orthotopic reconstruction between different cancer networks.
The team says this finding indicates the need to adjust for this variable in future studies examining patients and organizational variations in orthotopic reconstruction use.
"Our findings could serve as a benchmark for future prospective monitoring of orthotopic bladder reconstruction use in England."
"A specific procedure code to allow routine analysis of population-based nationwide data would be invaluable for ongoing monitoring of potential inequalities and unmet need," conclude Lyratzopoulos and colleagues.
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