Perioperative Outcomes and Early Survival in Octogenarians Who Underwent Radical Cystectomy for Bladder Cancer

Abstract

Objective: To evaluate perioperative outcomes and early survival in a series of octogenarians who underwent radical cystectomy (RC) and urinary diversion for bladder cancer. Patients and Methods: We retrospectively evaluated the clinical records of 44 patients aged ≥80 years who underwent open RC and urinary diversion at 2 high-volume centers between July 2013 and December 2015. Estimated blood loss (EBL), transfusion rate, and length of hospital stay (LOS) were evaluated. Ninety-day postoperative complications were stratified according to the type of urinary diversion. Univariable analysis was performed to identify predictors of overall and major complications. Overall survival (OS) was estimated using the Kaplan-Meier method. Results: Median age was 83 years (interquartile range [IQR] 81-85). Age-adjusted Charlson score was ≥4 in 37 (84%) patients, and American Society of Anesthesiologists score was ≥3 in 34 (77%) patients. Ileal conduit (IC) was performed in 21/44 (48%) cases, cutaneous ureterostomy (CU) in 20/44 (45%), and no urinary diversion was required for 3 (7%) dialytic patients. Median EBL was 700 mL (IQR 500-1,000) and 23 (52%) patients required blood transfusion. Median LOS was 13 days (IQR 10-18). Overall complications were recorded in 29 (66%) patients, with major complications observed in 12 (27%), with death occurring in 1. No differences in complications were observed between IC and CU. The 2-year OS estimate was 62.5%. Conclusions: Open RC in octogenarians has an acceptable rate of major complications and mortality. IC should be considered a good urinary diversion in these patients.

In-Hospital Outcomes after Radical Cystectomy for Bladder Cancer: Comparing National Trends in the United States and Germany from 2006 to 2014

“…Since almost every patient received incontinent UD in the United States, the clinical selection of older and frailer patients is likely to be masked [17]. Although these results imply a careful selection of older patients for RC, current studies showed acceptable rates of complications and mortality when older patients were treated in surgical centers [9].…”

“…The morbidity and mortality are among the highest in oncological surgery [3][4][5][6][7]. Influential factors are the high level of invasiveness combined with patient-derived factors such as the elevated mean patient's age and greater comorbidity [4,6,8,9].…”

Health-Related Quality of Life after Radical Cystectomy for Bladder Cancer in Elderly Patients with Ileal Orthotopic Neobladder or Ileal Conduit: Results from a Multicentre Cross-Sectional Study Using Validated Questionnaires

“…Despite data stated before, classic practice is to preserve QoL of elderly patients with an IC derivation [9], and to take advantage of its acceptable rate of major complications and mortality in octogenarians [10]. …”

Open radical cystectomy: lessons from the British Association of Urological Surgeons (BAUS) registry

“…Obviously, the high percentage of missing data (69%) is a strong limitation of the BAUS study preventing any consideration about this important outcome. In our experience, the 3-mo mortality rate ranged between 2% and 3% of cases, with higher percentage in patients aged >80 years ( 13 , 16 , 22 ). These percentages seem to be similar to those reported in contemporary RARC series ranging from 1% to 3.5% 3-mo after RARC ( 18 ).…”