Platinum Priority – Urothelial Cancer Editorial by Derek J. Rosario on pp. 1063–1065 of this issue Trends in Operative Caseload and Mortality Rates after Radical Cystectomy for Bladder Cancer in England for 1998–2010 Luke S. Hounsome a, *, Julia Verne a , John S. McGrath b , David A. Gillatt c a Public Health England Knowledge and Intelligence Team (South West), Bristol, UK; b Exeter Surgical Health Services Research Unit. Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; c North Bristol NHS Trust, Bristol, UK EUROPEAN UROLOGY 67 (2015) 1056–1062 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted December 1, 2014 Keywords: Cystectomy Bladder cancer Postoperative mortality Centralisation Survival trends Abstract Background: The Improving Outcomes in Urological Cancers guidelines recommended centralisation of cystectomy services to improve outcomes for bladder cancer (BCa) patients. Objective: To investigate trends in all-cause and cause-specific survival to see if there was an improvement in survival after centralisation was implemented. To analyse trends in the number of acute hospital trusts undertaking cystectomy. Design, setting, and participants: We used routine data to capture information on radical cystectomy (RC) in BCa patients aged 20 yr and older between 1998 and 2010 (n = 16 033). Outcome measurements and statistical analysis: We calculated 30-d and 90-d mortali- ty, and 30-d, 90-d, 1-yr, and 5-yr survival. The average number of RCs per trust was derived. Trends were identified using regression analysis. Results and limitations: The 30-d crude mortality decreased from 5.2% to 2.1% ( p < 0.001) and 90-d crude mortality decreased from 10.3% to 5.1% ( p < 0.001). There was an increase in 30-d relative survival from 96% to 98% ( p < 0.001), in 90-d relative survival from 91% to 96% ( p < 0.001), in 1-yr relative survival from 71% to 80% ( p < 0.001), and in 5-yr relative survival from 49% to 56% (2004–2006 data; p < 0.001). The mean number of RCs performed by trusts in England increased from six to 24 ( p < 0.001). Smoking status and stage at diagnosis were not available. Conclusions: Survival after RC has increased alongside decreases in short-term mortali- ty. There is little evidence of a cohort effect. The trends in survival are linear and we conclude that the continued survival improvements are a result of a combination of service improvements that include service reconfiguration, improved surgical training, neoadjuvant chemotherapy, enhanced recovery principles, and continued improve- ments in perioperative care. Patient summary: We analysed routinely collected hospital data. Outcomes for patients who undergo cystectomy have improved for all age groups. This is likely to be due to a combination of changes in practice. # 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Public Health England Knowledge and Intelligence Team (South West), 149 Whiteladies Road, Bristol BS8 2RA, UK. Tel. +44 117 9706474. E-mail address: luke.hounsome@phe.gov.uk (L.S. Hounsome). http://dx.doi.org/10.1016/j.eururo.2014.12.002 0302-2838/# 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.