An analysis of preoperative delays prior to radical cystectomy forbladder cancer in Quebec

  • Nader Fahmy Department of Surgery (Urology), McGill University, Montréal, QC
  • Wassim Kassouf Department of Surgery (Urology), McGill University, Montréal, QC
  • Suganthiny Jeyaganth Department of Surgery (Urology), McGill University, Montréal, QC
  • Moamen Amin Department of Surgery (Urology), McGill University, Montréal, QC
  • Salaheddin Mahmud Department of Community Heath Sciences, University of Manitoba, Winnipeg, Man
  • Jordan Steinberg Department of Surgery (Urology), McGill University, Montréal, QC
  • Simon Tanguay Department of Surgery (Urology), McGill University, Montréal, QC
  • Armen Aprikian Department of Surgery (Urology), McGill University, Montréal, QC

Abstract

Background: The province of Quebec has the highest incidence of urothelial
tumours in Canada. Radical cystectomy remains the standard treatment for invasive
bladder cancer. We have previously observed that prolonged delays between
transurethral resection of bladder tumour (TURBT) and radical cystectomy lead
to worse survival in Quebec.

Objective: The aim of our study was to characterize the various periods of delay
sustained by bladder cancer patients before radical cystectomy across Quebec
and to determine their relation to survival.

Methods: We obtained the billing records for all patients treated with radical
cystectomies for bladder cancer across Quebec from 1990 to 2002. Collected
information included patient age and sex; dates of family physician (FP) and
specialist visits with accompanying diagnoses; dates of cystoscopy, TURBT and
CT scanning; surgeon age; surgical volume and dates of death.

Results: We analyzed a total of 25 862 visits for 1633 patients. Median diagnostic
delays from FP to specialist, then to cystoscopy, then to TURBT and finally
from TURBT to CT were 20, 11, 4 and 14 days, respectively, over the entire
study period. Median overall delay from FP visit to radical cystectomy was
93 days. In addition, median FP to radical cystectomy delay progressively
increased from 1990 to 2000 from 58 to 120 days (p < 0.01). Multivariate analyses
showed that patients with an overall delay of either < 25 or > 84 days
had a 2.1 and 1.4 times increased risk of dying, respectively (p ≤ 0.01).

Conclusion: Preoperative delays have been progressively increasing over time.
Overall, delays from FP to radical cystectomy of < 25 and > 84 days may translate
into worse outcomes. Poor survival in cases with < 25 days delay may
be attributed to case selection, with more advanced cases being managed much
quicker. Poor survival in cases with delays of > 84 days may be attributed to
disease progression while awaiting completion of management.

Author Biographies

Nader Fahmy, Department of Surgery (Urology), McGill University, Montréal, QC
Wassim Kassouf, Department of Surgery (Urology), McGill University, Montréal, QC
Suganthiny Jeyaganth, Department of Surgery (Urology), McGill University, Montréal, QC
Moamen Amin, Department of Surgery (Urology), McGill University, Montréal, QC
Salaheddin Mahmud, Department of Community Heath Sciences, University of Manitoba, Winnipeg, Man
Jordan Steinberg, Department of Surgery (Urology), McGill University, Montréal, QC
Simon Tanguay, Department of Surgery (Urology), McGill University, Montréal, QC
Armen Aprikian, Department of Surgery (Urology), McGill University, Montréal, QC
How to Cite
Fahmy, N., Kassouf, W., Jeyaganth, S., Amin, M., Mahmud, S., Steinberg, J., Tanguay, S., & Aprikian, A. (1). An analysis of preoperative delays prior to radical cystectomy forbladder cancer in Quebec. Canadian Urological Association Journal, 2(2), 102-8. https://doi.org/10.5489/cuaj.482
Section
Original Research