Radical cystectomy (RC) is the current gold-standard treatment for muscle-invasive bladder cancer (MIBC) but is associated with notable morbidity and mortality risks. Although advancements in surgical techniques and peri-operative care have improved outcomes, challenges remain. Current European Association of Urology (EAU) guidelines define high-volume centers as those performing over 20 radical cystectomies per year. This study evaluates the impact of surgical volume on morbidity and mortality outcomes following open radical cystectomy (ORC). This includes a comparison of outcomes from a regional center performing a minimum of 10 ORC annually to those from established high-volume centers (≥20 ORC/year).

This retrospective cohort study analyzed patients who underwent ORC for urothelial malignancy at a 700-bed regional hospital in Australia, from 2018 to 2022. Key outcome measures included length of hospital stay, 30-day, 90-day, and 1-year all-cause mortality rates, as well as complication rates categorized by the Clavien-Dindo classification system. Comparative analyses were conducted against existing literature from recognized high-volume centers in Australia and the UK.

The study reviewed data from 64 patients, revealing a 30-day mortality rate of 1.83% and a 90-day mortality rate of 1.87%, comparable to New South Wales and UK rates. The 1-year all-cause mortality rate was observed at 3.65%. The median hospital length of stay was 13 days, exceeding the UK cohort average of 11 days. Complications classified as Clavien-Dindo grade I/II occurred in 49.1% of cases, significantly lower than the UK rate of 60.9%. Moreover, rates of grade III+ complications were markedly reduced at 18.8% compared to 31.4% in high-volume centers. These findings indicate that effective surgical practices can achieve favorable outcomes even in moderate-volume settings.

This study highlights the need to elevate surgical standards across all centers conducting radical cystectomy. The findings indicate that hospitals performing more than 10 procedures annually can achieve mortality and morbidity outcomes similar to those of high-volume centers. This suggests a need to reassess current volume-based definitions and advocate for the adoption of best practices to enhance patient safety and surgical quality in varied healthcare settings.