Benefit of radical cystectomy in the elderly patient with significant co-morbidities

Farnham, Scott B.; Cookson, Michael S.; Alberts, Gregory; Smith, Joseph A.; Chang, Sam S.

doi:10.1016/j.urolonc.2003.12.005

Cited by 65 publications

(30 citation statements)

References 14 publications

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“…25 Several recent studies have demonstrated that aggressive surgical treatment of invasive bladder cancer in elderly patients is beneficial and associated with acceptable morbidity. 26,27 However, a recent series noted that elderly patients were less likely than younger patients to receive adjuvant chemotherapy, despite the observations that they were likely to have higher stage disease at RC and decreased disease-free survival. 28 Given our current findings, impaired renal function likely significantly limits the widespread applicability of the results of perioperative chemotherapy trials in urothelial carcinoma completed to date.…”

Section: Discussionmentioning

confidence: 99%

Impact of renal impairment on eligibility for adjuvant cisplatin‐based chemotherapy in patients with urothelial carcinoma of the bladder

Dash

Galsky

Vickers

et al. 2006

Cancer

383

183

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BACKGROUND. Perioperative cisplatin‐based chemotherapy has shown benefit in patients with high‐risk localized urothelial bladder cancer, but it is not widely used. Renal impairment may be a major factor limiting its use. The current study was designed to determine the proportion of patients ineligible to receive adjuvant cisplatin‐based chemotherapy based on inadequate renal function alone. METHODS. Patients who underwent radical cystectomy for urothelial cancer of the bladder with evidence of extravesical disease (≥pT3 or any N+) were identified. Patients who received neoadjuvant chemotherapy were excluded. Serum creatinine immediately before and nadir serum creatinine after cystectomy were used to calculate creatinine clearance (CrCl) or glomerular filtration rate (GFR) using the Cockroft‐Gault (CG), Jelliffe, and Modification of Diet in Renal Disease (MDRD) study formulas. A cutoff of CrCl <60 mL/min or GFR <60 mL/min/1.73 m2 was used to determine ineligibility for cisplatin‐based chemotherapy. The proportion of patients ineligible by each formula was compared by univariate logistic regression. Univariate linear regression was performed to determine the effect of age on CrCl or GFR. RESULTS. Most patients were pT3 or greater; 39% were lymph node‐positive. The overall proportion of patients ineligible for cisplatin‐based chemotherapy was 28% by the CG formula, 52% by Jelliffe, and 24% by MDRD. Concordance between formulas was low. With all formulas the probability of ineligibility increased with age: by the CG equation, >40% of patients age >70 years were ineligible. CONCLUSIONS. The widespread use of cisplatin‐based perioperative chemotherapy in patients with high‐risk localized bladder cancer may be significantly limited by the high prevalence of baseline renal insufficiency in this population. This finding is most striking in the elderly. Better selection of patients who may safely receive cisplatin and more effective regimens devoid of cisplatin are required to optimize outcomes in this group of patients. Cancer 2006. © 2006 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Impact of renal impairment on eligibility for adjuvant cisplatin‐based chemotherapy in patients with urothelial carcinoma of the bladder

Dash

Galsky

Vickers

et al. 2006

Cancer

383

183

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“…In addition, surgery is still the most valid option to manage cancer complications (such as hydronephrosis and hematuria with resulting anemia) and thus, improves residual quality of life in selected patients. 9 However, surgical management of MIBC in elderly patients is challenging. Age and comorbidities often render these patients very poor candidates for radical surgery.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of radical cystectomy under combined spinal and epidural anesthesia in octogenarian patients with ASA score ≥3: A case series

Tzortzis

Dimitropoulos

Karatzas

et al. 2015

CUAJ

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Introduction: This study evaluated the feasibility and safety of open radical cystectomy (RC) under combined regional anesthesia (CRA) in high-risk octogenarian patients. Methods: We retrospectively evaluated the medical records of high-risk, octogenarian bladder cancer patients submitted to open RC with CRA. Demographic and clinical data, intraoperative parameters and perioperative and postoperative complications were recorded using the Clavien-Dindo classification. Results: In total, 14 male and 4 female patients, with a median age of 82.5 years were enrolled. Ureterocutaneostomy was performed in 15 patients and Bricker ileal conduit in the remaining 3. Operative time ranged from 97 to 184 minutes. Five patients were transfused and no major intraoperative complications occurred. Postoperative complications 30 days later included ileus (Grade II) in 3 patients, surgical trauma infection in 1 patient (Grade II), respiratory infection in 2 patients (Grade III), and hydronephrosis with concurrent urinary tract infection in 3 patients (Grade III). No deaths occurred. Conclusions: Our study showed that octogenarian, high-risk bladder cancer patients with indications for RC can safely undergo the surgical procedure under CRA, without apparent increase in major complications.

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“…Historically, urologists have shied away from performing cystectomies in the elderly population despite data showing a significant benefit in aggressive treatment of muscleinvasive bladder cancer in carefully selected patients [16][17][18][19][20][21]. Moreover, Franham et al demonstrated the safety of performing radical cystectomy in patients >75 years old with significant comorbidities based on an American Society of Anesthesiologists (ASA) classification of ≥3 [19].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, Franham et al demonstrated the safety of performing radical cystectomy in patients >75 years old with significant comorbidities based on an American Society of Anesthesiologists (ASA) classification of ≥3 [19]. Figueroa et al studied urinary diversion-related complications including urinary leak, intestinal anastomotic leak, and uretero-ileal obstruction and found them to be similar in patients younger and older than 70 years of age, 7.7 rate vs. 7.2 %, respectively [17].…”

Section: Discussionmentioning

confidence: 99%

Urinary Diversion in the Elderly

Ayoub

Westney

2015

Curr Bladder Dysfunct Rep

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The elderly or older population segment has a heterogenous definition in the literature with the majority including patients aged between 60 and 80 years. Several studies have proven that a cystectomy can be performed safely in the elderly population. We sought out to review the literature identifying the specific complications and the considerations requiring attention when performing a urinary diversion on an elderly patient. A review of literature performed using PubMed revealed paucity of citations specifically looking at different urinary diversion techniques and the specific complications related in an elderly population. However, we extrapolated additional data from articles that studied cystectomy surgical cohorts with identifiable age stratification. Particular complications and areas deserving of additional attention included gastrointestinal, renal, ureteroenteric anastomotic technique, metabolic disorders, quality of life, and voiding dysfunction. Detailed history and proper counseling of the patient and family are central to the selection of the appropriate urinary diversion technique and help maintain realistic patient expectations with a higher satisfaction rate. It is of paramount importance when considering continent urinary diversions to address the feasibility of adhering to a higher level of maintenance and the patient's ability to withstand diversionrelated complications.

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Benefit of radical cystectomy in the elderly patient with significant co-morbidities

Cited by 65 publications

References 14 publications

Impact of renal impairment on eligibility for adjuvant cisplatin‐based chemotherapy in patients with urothelial carcinoma of the bladder

Impact of renal impairment on eligibility for adjuvant cisplatin‐based chemotherapy in patients with urothelial carcinoma of the bladder

Feasibility and safety of radical cystectomy under combined spinal and epidural anesthesia in octogenarian patients with ASA score ≥3: A case series

Urinary Diversion in the Elderly

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