Perioperative Complications and 90-Day Mortality of Radical Cystectomy in the Elderly (75+): A Retrospective, Multicentre Study

Berger, Ingrid; Martini, Thomas; Wehrberger, Clemens; Comploj, E.; Ponholzer, Anton; Wolfgang, Martina; Breinl, Eckart; Dunzinger, Michael; Hofbauer, J.; Höltl, W.; Jeschke, Klaus Nielsen; Krause, Steffen; Kugler, Walter; Pauer, W; Rauchenwald, Michael; Pycha, Armin; Madersbacher, Stephan

doi:10.1159/000357127

Cited by 38 publications

(21 citation statements)

References 30 publications

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“…The method of data collection has been described elsewhere [14]. In brief, demographic, clinical and pathological data of all patients aged ≥75 years who underwent RC for MIBC at 11 institutions in Austria and South Tyrol between 2006 and 2010 were retrospectively collected and entered into an electronic database [14].…”

Section: Methodsmentioning

confidence: 99%

“…In brief, demographic, clinical and pathological data of all patients aged ≥75 years who underwent RC for MIBC at 11 institutions in Austria and South Tyrol between 2006 and 2010 were retrospectively collected and entered into an electronic database [14]. Informal institutional review board approval was obtained.…”

Section: Methodsmentioning

confidence: 99%

“…To address this issue in more detail, we analysed a fairly large cohort of patients (n = 256) aged ≥75 years who underwent RC [14]. We evaluate herein perioperative morbidity as assessed by the Clavien-Dindo classification as well as perioperative, 30- and 90-day mortality depending on whether bowel for urinary diversion was used or not.…”

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: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

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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“…RC also needs urinary diversion, a major change in lifestyle, and is not well tolerated by many patients. Besides, bladder cancers frequently occur in aged people, who may experience higher mortality and more complications following RC [5]. As a result, treatment regimens involving successful and safe bladder-sparing strategies are in great demand.…”

Section: Introductionmentioning

confidence: 99%

Intra-Arterial Chemotherapy for Muscle-Invasive Bladder Cancer Following Transurethral Resection

Liang

Zou²,

Han³

et al. 2015

Urol Int

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Purpose: To assess the efficacy of intra-arterial chemotherapy as a bladder-preservation treatment in patients with muscle-invasive bladder cancer (MIBC) following transurethral resection of bladder tumors (TURBT). Materials and Methods: From 2005 June to 2012 November, 46 patients diagnosed with MIBC (clinical stage T2-T3N0M0) underwent three courses of cisplatin-based intra-arterial chemotherapy as a remedial approach for bladder preservation after TURBT. All patients also received intravesical instillation of chemotherapy as a maintenance strategy. Results: All 46 patients completed the treatment with minor complications. The median follow-up time was 34.5 months (range, 8-87 months). Thirty-two patients (69.6%) demonstrated complete response. The three-year and five-year overall survival was 70.65 and 61.23%, and the disease-specific survival over the same periods was 78.03 and 67.62%, respectively. During the entire follow-up period, more than 80% preserved their bladder. Conclusions: Intra-arterial chemotherapy can be performed as a remedial treatment for MIBC patient following TURBT. Combined with TURBT, it offers an option for bladder preservation therapy on patients who are unable or unwilling to undergo radical cystectomy.

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“…The treatment aims to provide long-term survival with an acceptable quality of life. Reconstruction of the lower urinary tract using orthotopic bladder substitution has increased the acceptance of radical surgical treatment by both physicians and patients [1], including older age groups [2,3]. …”

Section: Introductionmentioning

confidence: 99%

Treatment and Outcomes of Urethral Recurrence of Urinary Bladder Cancer in Women after Radical Cystectomy and Orthotopic Neobladder: A Series of 12 Cases

et al. 2014

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Introduction: The incidence, treatment, and outcome of urethral recurrence (UR) after radical cystectomy (RC) for muscle-invasive bladder cancer with orthotopic neobladder in women have rarely been addressed in the literature. Patients and Methods: A total of 12 patients (median age at recurrence: 60 years) who experienced UR after RC with an orthotopic neobladder were selected for this study from a cohort of 456 women from participating institutions. The primary clinical and pathological characteristics at RC, including the manifestation of the UR and its treatment and outcome, were reviewed. Results: The primary bladder tumors in the 12 patients were urothelial carcinoma in 8 patients, squamous cell carcinoma and adenocarcinoma in 1 patient each, and mixed histology in 2 patients. Three patients (25%) had lymph node-positive disease at RC. The median time from RC to the detection of UR was 8 months (range 4-55). Eight recurrences manifested with clinical symptoms and 4 were detected during follow-up or during a diagnostic work-up for clinical symptoms caused by distant metastases. Treatment modalities were surgery, chemotherapy, radiotherapy, and bacillus Calmette-Guérin urethral instillations. Nine patients died of cancer. The median survival after the diagnosis of UR was 6 months. Conclusions: UR after RC with an orthotopic neobladder in females is rare. Solitary, noninvasive recurrences have a favorable prognosis when detected early. Invasive recurrences are often associated with local and distant metastases and have a poor prognosis.

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Perioperative Complications and 90-Day Mortality of Radical Cystectomy in the Elderly (75+): A Retrospective, Multicentre Study

Cited by 38 publications

References 30 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

Intra-Arterial Chemotherapy for Muscle-Invasive Bladder Cancer Following Transurethral Resection

Treatment and Outcomes of Urethral Recurrence of Urinary Bladder Cancer in Women after Radical Cystectomy and Orthotopic Neobladder: A Series of 12 Cases

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