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

Abstract

ObjectiveTo determine if significant differences exist in the perioperative outcomes of patients aged >75 years treated with radical cystectomy (RC) compared to younger patients, as RC is frequently not offered to ‘elderly’ patients with bladder cancer because of supposed increased risks of complications.Patients and methodsWe retrospectively analysed prospectively collected data of all patients that underwent RC in our centre from May 2013 to June 2015. In all, 81 consecutive RCs were identified and included in our study. Patients were divided into two age groups: Group A, aged <75 years (51 patients) and Group B, aged ≥75 years (30). Co-morbidities and perioperative outcomes were compared between the groups. Fisher’s exact test was used for statistical analysis.ResultsIn 68 patients RC was performed laparoscopically and the remaining 13 patients underwent open RC. The mean (range) age was 70.7 (36–85) years. There were 37 patients with muscle-invasive disease and 42 had non-muscle-invasive disease. The median hospital stay was not significantly different between the two age groups (10 vs 11 days). There was no significant difference in the preoperative Charlson co-morbidity index. The 30-day mortality rate was 4% for those aged <75 years and 6.6% for those aged ≥75 years, with overall perioperative complication rates of 57% vs 66%, respectively. Most complications were minor (Clavien–Dindo Grade I–II) and there was no statistically significant difference between the two cohorts. There was also no statistically significant difference in blood transfusion rates.ConclusionRC in patients aged ≥75 years has similar perioperative morbidity when compared with younger patients and can be offered in selected elderly patients. Thus, age should not be an absolute contraindication for RC.

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

“…About 20% of all complications were major (Clavien-Dindo Grade 3 or higher) among our patients, which is in line with published data [ 18 ]. In previous analyses, postoperative death rates after cystectomy varied from 0.3% to 7.9%, and we observed similar figures in our series [ 22 , 23 ]. The death rate was the greatest in patients aged ≥ 75 years; however, the overall death rate was low, so our sample was too small to look for predictors of death in multivariable analyses.…”

“…For example, Lee et al found no association of age with complication risk among 126 patients after robot-assisted radical cystectomy [ 24 ]. Similarly, other studies did not find a significant relationship between age and the risk of complications of radical cystectomy [ 21 , 23 , 25 ]. Among all the studied clinical factors, we found that only higher ASA scores tended to be associated with a greater risk of major complications (similarly to previous reports) [ 21 , 25 ].…”

A Personalized Approach to Radical Cystectomy Can Decrease Its 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 Extraperitoneal and Transperitoneal Radical Cystoprostatectomy in Terms of First 30 Days Outcomes

“…Bladder cancer remains the second most common urological malignancy in the world 11 . Radical cystectomy along with pelvic lymphadenectomy, being the gold standard treatment for bladder cancer is performed by the surgeons very frequently.…”