title: Pathological evaluation and quality of surgery in radical cystectomy in New South Wales, Australia.
abstract: BACKGROUND
  Australian bladder cancer patients especially women are thought to have worse outcomes when compared to the other international series. The objective of this study was to assess the pathological pattern of primary bladder cancer at the time of radical cystectomy as well as assessing the quality of resection in New South Wales.
  
  
  METHODS
  Pathology reports of radical cystectomy performed for primary bladder cancer were reviewed for a period of 10 years in a single major pathology centre servicing the state of New South Wales.
  
  
  RESULTS
  Two hundred one specimens reviewed over 10 years. The tumour stage at the time of cystectomy was: CIS 29 (14%), Tx,a 5 (2%), T1 24 (12%), T2 49 (24%), T3 57 (28%) and T4 37 (18%). Lymphovascular invasion was seen in 94 (47%). Soft tissue margins were positive in 31 (15%), pelvic lymph node dissection was not performed in 64 (32%) of patients and only 32 (16%) of the patients had 10 or more lymph nodes harvested. No significant differences between men and women were noted in tumour stages, soft tissue positive margin rates and performance of pelvic lymph node dissection. Improving trends were noted in rates of negative soft tissue margins and the lymph node count during this period.
  
  
  CONCLUSIONS
  Pattern of disease at the time of cystectomy was similar to the North American and European cohorts. Higher main specimen margin rates as well as lower lymph nodes retrieval rates were observed. No sex discrimination was observed. Further study is recommended to investigate the survival impact of this finding.
authors.affiliation: Urological Cancer Outcomes Centre and Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Nariman
authors.initials: N
authors.lastname: Ahmadi
authors.forename: Warick J
authors.initials: WJ
authors.lastname: Delprado
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Brooks
authors.forename: Phillip C
authors.initials: PC
authors.lastname: Brenner
authors.forename: Graham M
authors.initials: GM
authors.lastname: Coombes
authors.forename: Alexander
authors.initials: A
authors.lastname: Grant
authors.forename: Manish I
authors.initials: MI
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery*; D015653:Cystectomy / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009517:New South Wales; D010388:Pelvis; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012737:Sex Factors; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*
keywords: Australia; lymph node dissection; primary bladder cancer; quality of surgery; radical cystectomy