Radical cystectomy over the age of 75 is safe and increases survival

Abstract

BackgroundRadical cystectomy (RC) is probably underused in elderly patients due to a potential increased postoperative complication risk, as reflected by their considerable comorbidities. Our objective was to estimate the overall complication rate and investigate a potential benefit to patients over the age of 75 subjected to RC in terms of disease-free survival.MethodsA total of 81 patients, 61 men and 20 women, from two urological departments, with a mean age of 79.2 ± 3.7 years, participated in the study. The mean follow-up period was 2.6 ± 1.6 years. All patients underwent RC with pelvic lymphadenectomy. An ileal conduit, an orthotopic ileal neobladder and cutaneous ureterostomies were formed in 48.1%, 6.2% and 45.7% of the patients, respectively. The perioperative and 90-day postoperative complications were recorded and classified according to the modified Clavien classification system. Survival plots were created based on the oncological outcome and several study parameters.ResultsThe perioperative morbidity rate was 43.2%; the 90-day morbidity rate was 37%, while the 30-day, 90-day and overall mortality rates were 3.7%, 3.7% and 21%, respectively. Overall mortality rates were recorded at the final year of data gathering (2009). Increased age, increased body mass index (BMI), longer hospitalization and age-adjusted Charlson comorbidity index (ACCI) more than six, were associated with greater hazard for 90-day morbidity. The cumulative mortality / metastasis-free rates for one, two, three and five years were 88.7%, 77.5%, 70.4%, and 62.3%, respectively. Tumour stage and positive nodes were prognostic predictors for oncological outcome.ConclusionsRC in patients over 75 is justified and feasible, due to acceptable complication rates and high 5-year cancer-specific survival, which support an aggressive approach. Prospective studies are needed for the verification of the above results.

Comparison of Complications from Radical Cystectomy between Old-Old versus Oldest-Old Patients

“…Careful follow-up surveillance is therefore recommended in the first 90 days after RC. This has also been noted by Donat et al [23] and Tyritzis et al [13]. The average time of hospitalization between American and European patients was as follows: the European time of hospitalization was between 10 and 90 days (mean 24, median 21) and the American one was between 2 and 51 days (mean 11, median 9 days).…”

“…Large contemporary series with an average age of approximately 63 years show complication rates of 24-61% and 90-day mortality rates of approximately 10-37% [1,13]. Due to increased comorbidities, decreased physiological reserve and decreased ability to respond to stressors, elderly patients have an increased risk of complications [14,15].…”

Radical cystectomy in patients over 80 years old in Quebec: A population‐based study of outcomes

“…As elderly patients generally have more comorbid conditions, RC is often judged too risky by urologists . However, several studies have suggested that RC in octogenarians is underused and inappropriately denied .…”

“…However, multiple reports have advocated RC in the elderly and demonstrated that in selected older patients the outcomes are similar to younger patients . Furthermore, some reports have gone further and showed that RC is safe and effective even in high‐risk elderly patients with significant comorbidities .…”

Prediction of early postoperative complications of radical cystectomy with different method of urinary derivation through methods of mathematical modeling

“…Äàííûå, îïèñàííûå ðàíåå â ìèðîâîé ëèòåðàòóðå, ñâèäåòåëüñòâóþò î áîëåå âûñîêèõ ïîêàçàòåëÿõ ïåðèîïåðàöèîííûõ îñëîaeíåíèé ïîñëå ÎÐÖÝ ó ïîaeèëûõ ïàöèåíòîâ [21,22]. Îäíàêî äàííûé ôàêò (âëèÿíèå âîçðàñòà ïàöèåíòîâ íà ðàííèå è îòäàëåííûå ðåçóëüòàòû ÐÖÝ) â äàëüíåéøèõ èññëåäîâàíèÿõ íå áûë ïîäòâåðaeäåí.…”