Is It Safe to Offer Radical Cystectomy to Patients above 85 Years of Age? A Long-Term Follow-Up in a Single-Center Institution

Abstract

With a median age at diagnosis of 73 years, bladder cancer has the highest median age of all cancers. Age alone seems to be an independent risk factor for developing the disease with peak age advancing into the range of 85 years. As demographic changes will lead to an ever more aging population in western countries, incidence of advanced age malignancies will rise. We, therefore, analyzed a contemporary radical cystectomy (RC) series at a single high-volume center on patients undergoing RC for urothelial carcinoma of the bladder (UCB). We aim to evaluate the feasibility of RC in the oldest-old patient cohort by assessing perioperative complications and long-term outcome. Materials and Methods: We retrospectively analyzed data of 1,278 consecutive patients who underwent RC for UCB at our tertiary referral center between 2004 and 2019. A total of 408 patients were aged 75-97 years at the time of RC and were further divided into 2 groups: 75-84 years of age (group 1) and ≥85 years of age (group 2). Median follow-up was 23 months. Outcome was analyzed using the χ 2 test, Mann-Whitney U test, Kaplan-Meier method, and log-rank test. Results: Perioperative Clavien-Dindo grade ≥III complications were seen in 25.1% (92/366) of group 1 patients and 35.7% (15/42) of group 2 patients (p = 0.073). Thirty-and 90-day mortality was 3.3 and 8.7% in group 1 and 4.8 and 14.3% in group 2 (p = 0.617 and p = 0.242, respectively). Three-year overall survival was 54.6% in group 1 and 31.3% in group 2 (p = 0.03). Three-year cancer-specific survival was 64.8% in group 1 and 38.8% in group 2 (p = 0.037). Recurrence-free survival was 105 months in group 1 and 12 months in group 2 (p = 0.039). Conclusion: In light of increasing life expectancy in western nations, we sought to evaluate the impact of age in a large series of elderly patients undergoing RC for UCB. We found that RC offers acceptable perioperative complication rates in the oldest-old patient cohort (≥85 years). Therefore, RC for UCB can be offered as a viable treatment option even in the oldest patients.

Free Ferrous Protoporphyrin and Reactive Oxygen Species Status of Voided Urine Predicts Higher Stage in Urothelial Carcinoma

“…In addition, previous studies have reported that among patients who underwent radical cystectomy (RC) for urothelial carcinoma of the urinary bladder (UCB), patients in the old-age (≥75–84 years) group had a better overall and cancer-specific survival than those in the oldest-age (≥85 years) group, highlighting the benefit that easier and earlier diagnosis through FH and ROS may benefit older patients by providing potentially curative therapy. 16 The same problem also exists in UTUC. Furthermore, many RNUs are performed unnecessarily because of inaccurate preoperative staging of patients with UTUC.…”

Prognostic Value of Pretreatment Inflammatory Markers in Patients Receiving Radical Cystectomy for Urothelial Bladder Cancer: Does Age Matter?

“…In line with that, urologists are often faced with the difficult decision to offer such a complex surgery to elderly patients. Even though studies have shown that RC in elderly patients is not only feasible but safe [6], the influence of age on oncological outcomes remains unclear. To provide a strategy for risk stratification and therefore select patients which may benefit in long-term outcomes, previous studies have identified several biomarkers.…”

Salvage cystectomy and ileal conduit urinary diversion as a last‐line option for benign diseases—perioperative safety and postoperative health‐related quality of life

“…Since open cystectomy represents a highly complex procedure, it is known to be associated with non‐negligible morbidity 25,26 . Still, cystectomy has been shown to be safe even in the elderly patient with malignant disease and it has further been shown that perioperative complications do not necessarily impair postoperative HRQOL outcomes 27,28 . Cystectomy that is performed due to underlying benign conditions may be associated with a higher risk of morbidity and complications—for instance due to previous surgery or treatment like radiation 17,29 .…”

“…25,26 Still, cystectomy has been shown to be safe even in the elderly patient with malignant disease and it has further been shown that perioperative complications do not necessarily impair postoperative HRQOL outcomes. 27,28 Cystectomy that is performed due to underlying benign conditions may be associated with a higher risk of morbidity and complications-for instance due to previous surgery or treatment like radiation. 17,29 Cohn et al 17 and Al Hussein et al 6 reported overall 30-day complications rates of 73% and 65.5%, respectively, of which 47% and 20.7% had Clavien-Grade-III complications or higher.…”