How safe is teaching radical cystectomy? Results from the prospective Swiss society of urology database

TL;DR

This study shows that teaching radical cystectomy for bladder cancer is as safe as non-teaching procedures, despite some differences in outcomes.

Contribution

The study provides real-world evidence on the safety of teaching radical cystectomy using a national prospective database.

Findings

Teaching and non-teaching surgeries showed no significant differences in major outcomes like surgical resection and complication rates.

Teaching surgeries had fewer lymph nodes resected and higher transfusion rates compared to non-teaching surgeries.

The study confirms the safety of teaching radical cystectomy for a complex procedure.

Abstract

To provide a detailed description of the Swiss Society of Urology prospective database of radical cystectomy (RC) due to bladder cancer (BC) about differences in operative outcomes between teaching and non-teaching RC.

We collected the data of all RCs for BC from the register from March 2017 to March 2025, leading to 1587 cases. Afterwards, we decided about the extraction of 34 variables, e.g. operating approach and intraoperative complications. Furthermore, we determined that only complete data sets for our pre-defined variables will be included in the analysis, which led to 1304 RC cases.

Median patient age was 72.0 years (IQR 64.0–78.0). The majority of patients underwent open RC (n = 838; 64.3%). More than one quarter (n = 344; 26.4%) were teaching surgeries and there was no significant difference between both groups regarding demographic characteristics. There were no significant differences between teaching and non-teaching operative results in terms of surgical resection (R1 status; p = 0.295), duration of inpatient treatment (p = 0.394), infection (p = 0.023), wound healing disorders (p = 0.484), duration of surgery (p = 0.365), intraoperative bleeding (p = 0.635) and intraoperative blood loss (p = 0.074). However, in terms of the number of resected lymph nodes, blood transfusion rate, number of transfused packed red blood cells, intraoperative complications as well as the highest grade of complication during inpatient treatment teaching RC showed less favorable results, e.g. number of evaluated lymph nodes (teaching median 18.0 versus non-teaching median 20.0, p < 0.001).

Teaching RC is safe, for a high complex procedure, according to our prospective pilot study.

The online version contains supplementary material available at 10.1007/s00345-025-06173-4.