Perioperative and survival outcomes of laparoscopic radical cystectomy for bladder cancer in patients over 70 years

Abstract

IntroductionRadical cystectomy in elderly patients is a controversial issue that has noticed an increase in importance overtime because of the lengthening average life span. Our objective was to determine if there were significant differences in the perioperative outcomes of patients over 70 years with bladder cancer treated with laparoscopic radical cystectomy (LRC) compared to those of younger patients.Material and methodsWe selected 180 patients who underwent LRC in our department in the period between 2005-2012. We divided them into 2 groups: 57% <70 years and 43% >70 years, and we compared the different parameters such as: comorbidities, intraoperative and post-operative complications, TNM stage and overall survival.ResultsThe group <70 years had less comorbidities when compared with the group >70 years. Heterotopic urinary diversion was the diversion of choice in the elderly patients (97.4%). Paralytic ileus and the worsening of renal function were the only complications with statistical differences between the groups. Mean hospital length of stay was not significantly different between the groups. Younger and older patients had similar pathological staging : pT1 or less: 26,2 vs. 18.2%, pT2: 19.4 vs. 16.9%, pT3 38.8 vs. 37.7% and pT4 15.6 vs. 17.2%. Kaplan-Meier curves did not show significant differences in survival.ConclusionsLaparoscopic radical cystectomy in the elderly patient has similar rates of perioperative morbidity when compared with the younger patient and may be offered as a treatment option in selected elderly patients.

Radical cystectomy in the elderly – Is this a safe treatment option?

“…The expansion of the elderly population is putting ever increasing pressure on urological surgery, not least the surgical treatment of bladder cancer [2] , [3] , [4] . With the average life expectancy in the UK now 81.4 years for males and 84.6 years for females, and with 8% of the total populations now aged >75 years [16] , attitudes must change when considering patients for radical surgery.…”

“…Bladder cancer remains the second most common urological malignancy in the Western world, with the highest incidence in the elderly population [1] , [2] , [3] , [4] . In the UK, it is estimated that people aged ≥75 years account for more than half of the cases of bladder cancer diagnosed each year [5] .…”

“…Some authors have reported a higher incidence of both minor and major complications in the elderly with complication rates as high as 64% [7] and prolonged postoperative hospital stay [8] . There is still considerable debate in the literature as to whether patients aged >70 years are suitable for such radical surgery [2] , [8] , [9] .…”

“…Advances in minimally invasive surgical techniques have facilitated a drive to offering radical surgery to elderly patients who previously would have been treated conservatively or offered radical radiotherapy [2] , [9] , [10] , [11] . This minimally invasive approach has many advantages including reduced intraoperative blood loss and postoperative analgesic requirements, whilst facilitating earlier mobility leading to a shorter perioperative admission and possibly lower complication rates [9] , [10] , [11] , [12] .…”

Application of Laparoscopic Radical Cystectomy and Urinary Diversion based on 3D Technique

“…In the 19th century, the first complete resection of bladder cancer was successfully performed. With the development of medical technology, traditional open surgery is replaced by laparoscopic surgery [2] . The patient recovers faster and the hospital stay is shorter.…”