Bladder Preservation in Octogenarians With Invasive Bladder Cancer

Wehrberger, Clemens; Berger, Ingrid; Marszalek, Martin; Ponholzer, Anton; Wehrberger, Marlies; Rauchenwald, Michael; Madersbacher, Stephan

doi:10.1016/j.urology.2009.10.027

Cited by 16 publications

(15 citation statements)

References 17 publications

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“…Despite the lower complication rate of UC, the 90-day mortality within the UC cohort was substantially higher (17.3 vs. 6.9%). While the mortality of the bowel group is within the range of published multicentre series of elderly patients (≥75 years) who underwent cystectomy [13], the 90-day mortality rate in the UC cohort was high (17.3%). This high mortality rate was not driven by inpatient mortality (5.8%); the majority of patients died after the initial discharge mainly for medical complications.…”

Section: Discussionmentioning

confidence: 95%

“…It is beyond the scope of this paper to discuss alternatives to RC in elderly patients with MIBC, such as repeat transurethral resection of bladder tumour or multimodal approaches including radiochemotherapy [6,10,13,25]. All approaches have significant advantages and disadvantages, and due to the lack of randomised trials, no clear conclusions can be drawn to date.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, RC is frequently withheld in elderly and geriatric patients [4]. Hollenbeck et al reported that aggressive surgical management of BC in elderly patients may improve survival, though the optimal management of elderly patients with MIBC remains controversial [10,11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

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Impact of the Use of Bowel for Urinary Diversion on Perioperative Complications and 90-Day Mortality in Patients Aged 75 Years or Older

et al. 2015

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Objective: A potential strategy to decrease the high complication rate of radical cystectomy (RC) in the elderly is to avoid the use of bowel for urinary diversion. The aim of this study was to address this issue in a multicentre study of patients aged ≥75 years. Patients and Methods: We performed a retrospective, multicentre study of a consecutive series of patients aged ≥75 years who underwent RC for muscle-invasive bladder cancer between 2006 and 2010. Medical, surgical and wound complications were graded according to the modified Clavien-Dindo classification. Results: A total of 256 patients (68% men, mean age 79.6 years) were analysed. 204 (80%) patients received a urinary diversion with use of bowel and 52 (20%) a ureterocutaneostomy (UC). Patients with UC were older (82.0 vs. 78.9 years, p < 0.001) and had a higher ASA score (2.6 vs. 2.3, p = 0.007), while the mean Charlson score was lower (4.2 vs. 5.6, p < 0.001). Patients with UC had a shorter operating time (279 vs. 311 min, p = 0.002) and a shorter period in the intensive care unit (0.9 vs. 2.2 days). The overall rate of severe complications graded as Clavien III-V was significantly lower in the UC group (11.5%) as compared to patients receiving bowel for urinary diversion (25.0%) (p = 0.003). Severe (Clavien grade III-V) medical (3.9 vs. 10.3%) and surgical (2.1 vs. 14.1%) complications were all less frequent in the UC group. Inpatient, 30- and 90-day mortality was 5.8, 7.7 and 17.3% in the UC group as compared to 3.9, 5.9 and 6.9% in the bowel cohort, respectively. Conclusion: UC following RC is associated with a lower complication rate in geriatric patients. The constantly increasing cohort of geriatric, multimorbid patients requiring cystectomy might justify reconsideration of this form of diversion.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Impact of the Use of Bowel for Urinary Diversion on Perioperative Complications and 90-Day Mortality in Patients Aged 75 Years or Older

et al. 2015

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“…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).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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Introduction: The aim of this study was to compare overall survival in elderly patients (≥ 80 years) with muscle-invasive bladder cancer (MIBC) undergoing either radical cystectomy (RC) or conservative treatment. Material and Methods:We performed a retrospective, comparative analysis of overall-and cancer-specific survival in octagenarians with MIBC (> pT2) submitted to RC or conservative treatment. Uni-and multivariable Cox regression analysis were performed to assess predictors of overall survival. Cumulative hospital stay was also analyzed for all patients. Results: The RC-group consisted of 33 patients with a mean age of 82.3 years (IQR 80.4-85.4 years) and the bladder preservation a cohort of 35 patients aged 83.8 years (IQR 81.8-88.2 years). no difference was detectable for overall survival (15.9 months versus 9.5 months; p = 0.18) and cancer-specific survival (23.5 months versus 19.5 months p = 0.71) or 90-day mortality (6.1% versus 14.3%; p = 0.43) between the two groups. Patients who received conservative treatment had a shorter cumulative length of hospital stay (p = 0.001). Age at the time of transurethral resection of the bladder (TUR-B) was an independent predictor of the overall survival (p = 0.004). Conclusions: In this retrospective study, no clear survival benefit was observed for patients ≥ 80 years submitted either to radical cystectomy or conservative treatment. There was however a trend favoring radical cystectomy but this did not approach statistical significance. Octagenarians that underwent RC however spent more of their remaining lifetime in the hospital than those treated conservatively.

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“…Improvements in surgical and pre- and postoperative care have occurred making RC a safer procedure even in elderly patients [8], it is however often avoided due to concerns about higher morbidity and mortality rates [3]. Hollenbeck et al [9] reported that aggressive surgical management of BC in elderly patients may improve survival, but the optimal management of elderly patients with muscle-invasive BC is controversial [10,11,12]. …”

Section: Introductionmentioning

confidence: 99%

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

Comploj¹,

West

Mian

et al. 2014

Urol Int

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Introduction: The purpose of this study was to evaluate and compare complications after radical cystectomy in patients aged ≥75 years. Materials and Methods: 251 patients aged 75-95 years (median 79) underwent radical cystectomy between 2000 and 2012 at four institutions. The patients were divided into two groups: ≥75-84 years of age (group 1) versus ≥85 years of age (group 2). Comorbidities, body mass index, and complications were obtained retrospectively, except at the Central Hospital of Bolzano and Weill Cornell Medical Center, which collected data prospectively. Cancer-specific survival, overall mortality, hospital stay, clinical outcome and complications were assessed. Complications were categorized using the Clavien-Dindo classification reporting system. The mean follow-up was 21 months. Results: The median hospital stay was 17 (2-91) days. Perioperative Clavien-Dindo grade ≥III complications were seen in 24.1% (48/199) of group 1 patients and 19.2% (10/52) of group 2 patients (p = 0.045). 30- and 90-day mortality was 4.5 and 13.5% in group 1 and 6.5 and 32.3% in group 2, respectively. Only the 90-day mortality rate was statistically significant (p < 0.05) between the two groups. The 3-year overall survival was 40% in group 1 and 34% in group 2. The 3-year cancer-specific survival was 52% in group 1 and 50% in group 2. Conclusions: We evaluated a large series of elderly (≥75 years) patients undergoing radical cystectomy at four institutions. Comparing patients aged ≥75-84 and ≥85 years revealed no significant difference in complications, 30-day mortality, overall and cancer-specific survival rates. Only 90-day mortality rates were significantly higher in the ≥85-year-old patients.

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Bladder Preservation in Octogenarians With Invasive Bladder Cancer

Cited by 16 publications

References 17 publications

Impact of the Use of Bowel for Urinary Diversion on Perioperative Complications and 90-Day Mortality in Patients Aged 75 Years or Older

Impact of the Use of Bowel for Urinary Diversion on Perioperative Complications and 90-Day Mortality in Patients Aged 75 Years or Older

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

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

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