Radical Cystectomy in the Octogenarian

Stroumbakis, Nicholas; Herr, Harry W.; Cookson, Michael S.; Fair, William R.

doi:10.1016/s0022-5347(01)68171-0

Cited by 123 publications

(75 citation statements)

References 18 publications

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“…Studies of patients aged > 70 years found the mean hospital stay after RC to be 11-28 days [3,15]. In addition, patients aged > 79 years were found to be re-admitted to the hospital 66% of the time within 6 months of RC, for either medical or surgical complications [16]. A long hospital stay combined with recovery of function after the hospitalization can be a significant proportion of an elderly patient's remaining life, and should be factored into the decision to proceed with RC.…”

Section: Discussionmentioning

confidence: 99%

Cystectomy in the elderly: does the survival benefit in younger patients translate to the octogenarians?

Chamie

White

et al. 2008

BJU International

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OBJECTIVETo determine whether the survival benefit achieved with radical cystectomy (RC, the reference standard for treating muscle‐invasive bladder cancer) in younger patients justifies its use in octogenarians.PATIENTS AND METHODSWe used the Surveillance Epidemiology and End Results data of the National Cancer Institute and identified 10 807 patients from 1992–2004 who were diagnosed with muscle‐invasive bladder cancer, and were treated with either RC or radiotherapy. The data were analysed for age, gender, race, extent of lymphadenectomy and cause of death. We stratified the patients by age groups (<60, 60–69, 70–79 and >79 years), and used Kaplan‐Meier survival analysis to compare treatment strategies by age group.RESULTSIn all, 8034 patients had RC and 2773 radiotherapy; RC was the primary method of treatment in all age groups except for octogenarians. Those who had RC had a sizeable overall survival advantage in all age groups, except for the octogenarians (18 vs 15 months). This small survival advantage improved only slightly (23 vs 15 months) when excluding patients having nodal or distant metastasis. The octogenarians who have RC with a limited pelvic lymph node dissection or RC alone receive little (16 vs 15 months) or no survival benefit. However, cancer‐specific survival was significantly higher in those who had RC, including octogenarians.CONCLUSIONSOctogenarians have some benefit to cancer‐specific survival from RC if it includes a standard lymphadenectomy. The issue is how to better select the patients, as the overall survival advantage in these patients over radiotherapy is negligible.

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Section: Discussionmentioning

confidence: 99%

Cystectomy in the elderly: does the survival benefit in younger patients translate to the octogenarians?

Chamie

White

et al. 2008

BJU International

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“…Nevertheless, several centers specifically evaluating RC in the elderly have concluded that RC may be performed with a higher but acceptable morbidity rate 7,8,17,18 .…”

Section: Resultsmentioning

confidence: 99%

“…While several centers have concluded that RC may be performed with a higher but acceptable morbidity rate [6][7][8] , its role in elderly patients is still in debate due to the associate morbidity.…”

Section: Muscle Invasive Bladder Cancer (Mibc) Accounts Formentioning

confidence: 99%

Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy

et al. 2013

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PURPOSE: Simple diversions are underutilized, mostly for unfit, bedridden, and very self-limited patients requiring palliative surgical management due to life-threatening conditions. Experience with cutaneous ureterostomy (CU) as palliative urinary diversion option for unfit bladder cancer patients is reported. METHODS: We retrospectively reviewed clinical and operative parameters of 41 patients who underwent CU following RC in three specialized Cancer Centers from July/2005 to July/2010. Muscle-invasive disease (clinical Stage T2/worse), multifocal high-grade tumor, and carcinoma in situ refractory to intravesical immunotherapy were the main indications for RC. Double-J ureteral stents were used in all patients and replaced every 6 months indefinitly. Peri-operative morbidity and mortality were evaluated. RESULTS: Median age was 69 years (interquartile range - IQR 62, 76); 30 (73%) patients were men. Surgery in urgency setting was performed in 25 (61%) of patients, most due to severe bleeding associated with hemodynamic instability; 14 patients (34%) showed an American Society of Anesthesiologists score 4. Median operative time was 180 minutes (IQR 120, 180). Peri-operative complications occurred in 30 (73%) patients, most Clavien grade I and II (66.6 %). There was no per-operative death. Re-intervention was necessary in 7 (17%) patients. Overall survival was 24% after 9.4 months follow-up. CONCLUSIONS: CU with definitive ureteral stenting represents a simplified alternative for urinary diversion after palliative cystectomy in unfit patients. It can be performed quickly, with few early and late postoperative complications allowing RC in a group of patients otherwise limited to suboptimal alternatives. Future studies regarding the quality of life are warranted.

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“…The mortality rate of urinary diversion by an ileal conduit or neobladder reconstruction was 0-4.5% in varied studies which is similar to the present study using CU of urinary diversion with no mortality. [20][21][22][23][24][25][26][27] It is an observational, retrospective study and the sample size is small.…”

Section: Discussionmentioning

confidence: 99%

Indications and outcome of patients undergoing cutaneous ureterostomy as a mode of urinary diversion after radical cystectomy: an experience from a tertiary care center

et al. 2018

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Background: Radical cystectomy is associated with high morbidity, especially in elderly patients. Most of the associated complications are related to the urinary diversion. Cutaneous ureterostomy (CU) is usually an uncommon form of urinary diversion and is avoided because of the frequent complication of stomal stenosis.Methods: In this study the authors retrospectively analyzed 84 patients who underwent radical cystectomy. 17 Patients who underwent single stoma CU were included in the study who required lifelong monthly stent changes. Varied indication and outcome of these patients were analyzed.Results: Patients in which CU was used as a mode of urinary diversion had less blood loss, less operative time and discharged without ICU stay.Conclusions: It seems that single stoma CU is a viable option in elderly, high risk patients and in post radiotherapy patients who require radical cystectomy. Although the patient requires lifelong stent changes, postoperative complications are reduced.

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Radical Cystectomy in the Octogenarian

Abstract: The results of this study support the use of cystectomy in octogenarians with invasive bladder cancer. Surgery can be accomplished with acceptable morbidity and mortality. Radical cystectomy in this population offers the best opportunity for sustained disease-free quality survival.

Cited by 123 publications

References 18 publications

Cystectomy in the elderly: does the survival benefit in younger patients translate to the octogenarians?

Cystectomy in the elderly: does the survival benefit in younger patients translate to the octogenarians?

Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy

Indications and outcome of patients undergoing cutaneous ureterostomy as a mode of urinary diversion after radical cystectomy: an experience from a tertiary care center

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