Increased Use of Cystectomy in Patients 75 and Older: A Contemporary Analysis of Survival and Perioperative Outcomes From the National Cancer Database

Bream, Matthew J.; Maurice, Matthew J.; Altschuler, Joshua; Zhu, Hui; Abouassaly, Robert

doi:10.1016/j.urology.2016.08.054

Cited by 25 publications

(18 citation statements)

References 22 publications

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“…We observed a slight, albeit not statistically significant, increase in patient’s age at the time of RC from a median of 67 years in 2004 to 72 years in 2019. These results correspond to the data analyzed by Bream et al [22], showing an increase in RC offered to patients aged ≥75 years from 14% in 2003 to 24% in 2012, with a considerable survival benefit for RC. Considering the increasing life expectancy, Horovitz et al [23] analyzed data of 605 patients who underwent RC for UCB from 1985 to 2010.…”

Section: Discussionsupporting

confidence: 90%

Is It Safe to Offer Radical Cystectomy to Patients above 85 Years of Age? A Long-Term Follow-Up in a Single-Center Institution

et al. 2020

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With a median age at diagnosis of 73 years, bladder cancer has the highest median age of all cancers. Age alone seems to be an independent risk factor for developing the disease with peak age advancing into the range of 85 years. As demographic changes will lead to an ever more aging population in western countries, incidence of advanced age malignancies will rise. We, therefore, analyzed a contemporary radical cystectomy (RC) series at a single high-volume center on patients undergoing RC for urothelial carcinoma of the bladder (UCB). We aim to evaluate the feasibility of RC in the oldest-old patient cohort by assessing perioperative complications and long-term outcome. Materials and Methods: We retrospectively analyzed data of 1,278 consecutive patients who underwent RC for UCB at our tertiary referral center between 2004 and 2019. A total of 408 patients were aged 75-97 years at the time of RC and were further divided into 2 groups: 75-84 years of age (group 1) and ≥85 years of age (group 2). Median follow-up was 23 months. Outcome was analyzed using the χ 2 test, Mann-Whitney U test, Kaplan-Meier method, and log-rank test. Results: Perioperative Clavien-Dindo grade ≥III complications were seen in 25.1% (92/366) of group 1 patients and 35.7% (15/42) of group 2 patients (p = 0.073). Thirty-and 90-day mortality was 3.3 and 8.7% in group 1 and 4.8 and 14.3% in group 2 (p = 0.617 and p = 0.242, respectively). Three-year overall survival was 54.6% in group 1 and 31.3% in group 2 (p = 0.03). Three-year cancer-specific survival was 64.8% in group 1 and 38.8% in group 2 (p = 0.037). Recurrence-free survival was 105 months in group 1 and 12 months in group 2 (p = 0.039). Conclusion: In light of increasing life expectancy in western nations, we sought to evaluate the impact of age in a large series of elderly patients undergoing RC for UCB. We found that RC offers acceptable perioperative complication rates in the oldest-old patient cohort (≥85 years). Therefore, RC for UCB can be offered as a viable treatment option even in the oldest patients.

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Section: Discussionsupporting

confidence: 90%

Is It Safe to Offer Radical Cystectomy to Patients above 85 Years of Age? A Long-Term Follow-Up in a Single-Center Institution

et al. 2020

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“…Rather, our present results suggest that elderly patients received less effective treatment if progression occurred. A recent population‐based analysis from the USA showed that, although RC use in elderly patients is increasing, still only 24% of patients with MIBC aged >75 years receive RC . The lower odds for older patients to receive RC were independent of comorbidity.…”

Section: Discussionmentioning

confidence: 99%

The World Health Organization 1973 classification system for grade is an important prognosticator in T1 non‐muscle‐invasive bladder cancer

et al. 2018

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“…[7][8][9] Moreover, RC has demonstrated improved survival compared with nonstandard treatment in elderly patients. 10 In order to improve postoperative outcomes in high-risk patients undergoing major abdominal surgery, continuous spinal anesthesia (CSA) is gaining popularity as a better tolerated technique, with a more predictable effect and lesser hemodynamic and respiratory repercussions than general anesthesia (GA) in high-risk patients. 11,12 The aim of this pilot study was to assess the feasibility, morbidity, and mortality of RC performed in CSA in the first five octogenarian patients, who were unfit for GA.…”

Section: Introductionmentioning

confidence: 99%

Radical cystectomy in frail octogenarians in thoracic continuous spinal anesthesia and analgesia: a pilot study

Castellani

Starnari

Faloia

et al. 2018

Therapeutic Advances in Urology

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Background: Radical cystectomy (RC) is the gold standard therapy in nonmetastatic muscleinvasive bladder cancer and is usually performed under general anesthesia (GA). GA is high risk in most older patients due to comorbidities. Continuous spinal anesthesia (CSA) may be an alternative solution to reduce postoperative morbidity in elderly. The aim of this study was to assess the feasibility, morbidity, and mortality of RC performed under CSA in octogenarian patients. Methods: We retrospectively reviewed data of five frail patients aged ⩾80 who underwent RC in CSA. CSA was achieved starting with 2.5 mg hyperbaric bupivacaine plus 25 µg fentanyl. Postoperative analgesia was achieved through the intrathecal catheter, using continuous delivery of levo-bupivacaine 60 mg plus fentanyl 75 µg in 72 hours. Results: Surgery was completed in all cases in CSA. No patients required postoperative intensive care unit admission. Complications were Clavien I for four in three patients, Clavien II for seven in five patients, and Clavien IIIb for one patient. Postoperative consumption of painkillers was negligible. Oral feeding resumed within 3 days in all cases. The mean postoperative stay was 9.6 days. All patients were alive at 3 months of follow up. Conclusions: Management of muscle-invasive bladder cancer (MIBC) in older patients is becoming an important issue due to the continuous aging of the population. Age should not preclude RC, but careful management is mandatory because perioperative morbidity and mortality are increased in the elderly. Our preliminary results show that CSA and analgesia is a feasible option as an additional way to reduce morbidity and mortality in frail octogenarians who require RC.

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Increased Use of Cystectomy in Patients 75 and Older: A Contemporary Analysis of Survival and Perioperative Outcomes From the National Cancer Database

Cited by 25 publications

References 22 publications

Is It Safe to Offer Radical Cystectomy to Patients above 85 Years of Age? A Long-Term Follow-Up in a Single-Center Institution

Is It Safe to Offer Radical Cystectomy to Patients above 85 Years of Age? A Long-Term Follow-Up in a Single-Center Institution

The World Health Organization 1973 classification system for grade is an important prognosticator in T1 non‐muscle‐invasive bladder cancer

Radical cystectomy in frail octogenarians in thoracic continuous spinal anesthesia and analgesia: a pilot study

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