Age and risk of major complications in patients undergoing radical cystectomy for muscle invasive bladder cancer.

Abstract

Introduction Radical cystectomy is the treatment of choice for patients with muscle invasive bladder cancer (MIBC), but it may be unsafe in older patients. Aim In this study, we investigated whether age and selected clinical characteristics were associated with outcomes of radical cystectomy. Material and methods We enrolled 434 patients with MIBC who underwent radical cystectomy between 2012 and 2016, and we classified them into three age groups: < 65, 66–74, and ≥ 75 years. Postoperative complications were classified on the Clavien-Dindo scale. Regression models were used to find predictors of major postoperative complications (Clavien-Dindo score of 3 or more), long hospital stay (> 7 days), blood loss, and operating time. The models included American Society of Anesthesiologists scores, age group, sex, body mass index, Tumor Nodes Metastasis scores, type of urine derivation (ileal conduit or orthotopic bladder vs. ureterocutaneostomy), and operation type (open vs. laparoscopic). Results In the regression models, age was not a significant predictor of major complications, long hospital stay, or blood loss (p ≥ 0.206). Older age was associated with shorter surgery times (p = 0.002). Higher preoperative American Society of Anesthesiologists scores tended to be associated with a greater risk of major complications (odds ratio, 1.47; p = 0.092). Conclusions Older age was not associated with an increased risk of major complications in patients who undergo radical cystectomy because of MIBC. Therefore, older age alone should not be a contraindication to this operation.

A Personalized Approach to Radical Cystectomy Can Decrease Its Complication Rates

“…With precise preoperative preparation, meticulous intraoperative hemostasis, a minimally invasive method of surgery (laparoscopic or robot-assisted), and the correct post-operative management, it is possible to significantly reduce surgery complication rates. In our previous study, older age alone did not increase the risk of major postoperative complications, prolonged hospital stays, or blood loss among patients who were subjected to radical cystectomy [30]. This concurs with other studies [31][32][33].…”

Comparison of long-term outcomes between ileal conduit and transuretero-cutaneostomy urinary diversion after radical cystectomy: a systematic review and meta-analysis

“…This would increase the hospitalization duration, which is higher in IC patients. Adamczyk et al [13] reported that IC becomes a significant predictor of prolonged hospital stay (> 7 days) compared to TUU, with an odds ratio of 6.13 (95% CI: 3.40-11.39, p < 0.001). Our meta-analysis found that the IC group had a significantly higher mean duration of hospitalization than the TUU group, with a mean difference of 3.80 (95% CI: 2.27-5.32; p < 0.001; I 2 = 92%).…”

“…DeNunzio et al [12] and Fuschi et al [14] reported a higher complication rate (CDCS grade ≥ 3) in the IC group. In contrast, six other studies reported no difference in the proportion of major complications (CDCS grade ≥ 3) between the two groups [9,13,[18][19][20][21]. Moreover, Kadoriku et al [18] reported no significant difference in the proportion of major complications in 2 different periods, 30 days and 90 days postoperatively.…”

“…Most of the studies reported a higher duration of hospitalization in the IC group [11][12][13][14][15][16][17]. Four other studies reported no significant difference in duration of hospitalization in the IC and TUU groups.…”