The dilemma of cystectomy in old-old and oldest-old patients

Abstract

Bladder cancer (BC) is a disease of the elderly, with a peak incidence at 85 years. If life expectancy continues to increase in such a way that it is, in 20 years nearly half of the population will be considered elderly. The incidence of BC will also dramatically increase in proportion to this and, subsequently, a cure is needed. Currently, only 4-11% of elderly individuals with muscle-invasive BC undergo radical extirpative surgery; a number that is evidently too low when we consider that the cancer-specific mortality rate is highest in the octo- and nona-genarian groups. Advanced age should not in itself be a reason for avoiding radical surgery. Comorbidity is much more important and incisive on complication and mortality rate than age alone. Nevertheless, a complication rate of 24-60% is a realistic expectation, as is a 90-day mortality rate of approximately 10%. Due to the restricted physiological reserve, there is little place for surgical mistakes. This review evaluates all aspects of radical cystectomy in the elderly and gives an overview of upcoming challenges.

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

“…In the coming decades, demographic changes in Western countries will result in a further aging population [20]. The incidence of BC also increases with age and is 11-fold higher in patients ≥65 years compared to patients <65 years.…”

“…The incidence of BC also increases with age and is 11-fold higher in patients ≥65 years compared to patients <65 years. In addition, elderly patients (≥65 years) have a 16-fold higher BC mortality rate compared to patients <65 years, and this increases with advanced age [20,21,22]. Age also represents a strong and independent risk factor for the presence of BC, as the peak age for BC is advancing and now estimated at 85 years [20,22].…”

“…In addition, elderly patients (≥65 years) have a 16-fold higher BC mortality rate compared to patients <65 years, and this increases with advanced age [20,21,22]. Age also represents a strong and independent risk factor for the presence of BC, as the peak age for BC is advancing and now estimated at 85 years [20,22]. Elderly patients with increased comorbidities, decreased physiologic reserve and advanced tumor stage present a therapeutic dilemma [14].…”

Comparison of Radical Cystectomy with Conservative Treatment in Geriatric ( 80) Patients with Muscle-Invasive Bladder Cancer

“…In addition, RC demonstrates a 3-5-fold higher perioperative mortality in septuagenarians (5.4%) and octogenarians (9.2%) in comparison to patients ≤ 69 years (2%) (5). Some studies, however, have demonstrated that selected older patients have similar peri-operative outcomes as younger patients (6)(7)(8). Bladder sparing treatment in a selected group of octogenarians has also been successfully demonstrated by Wehrberger et al (9).…”

Metastatic Urothelial Cancer of the Bladder Cancer Presented for the First Time in its Final Stage: Case Report and Literature Review

“…Currently, only 4-11% of individuals at advanced ages that present muscle-invasive cancer undergo radical dissecting surgery, with a rate of complications of 24-60%, and a 90-day mortality rate of 10% [15].…”