Radical Cystectomy Is Safe in Elderly Patients at High Risk

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

doi:10.1016/s0022-5347(05)65868-5

Cited by 119 publications

(26 citation statements)

References 14 publications

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“…Lack of association may be secondary to relative lack of sensitivity of ASA and limited sample size. Chang et al [24] also used ASA scores and had relatively small samples sizes, which may have contributed to their negative results.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Comorbidity in Patients with Bladder Cancer

Megwalu¹,

Vlahiotis²,

Radwan³

et al. 2008

European Urology

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Objective-To determine the impact of comorbidity on survival of bladder cancer patients.Methods-The population included 675 patients with newly diagnosed bladder cancer whose medical information was abstracted from a hospital cancer registry. Adult Comorbidity Evaluation-27, a validated instrument, was used to prospectively categorize comorbidity. Independent variables assessed include comorbidity, American Joint Committee on Cancer (AJCC) stage, grade, age, gender, and race. Outcome measure was overall survival. We analyzed the entire cohort, patients with noninvasive disease, and patients requiring cystectomy. Cox proportional hazards analysis was used to assess impact of independent variables on survival.Results-Median age at diagnosis for the entire cohort was 71 yr and median follow-up was 45 mo. Of 675 patients, 446 had at least one comorbid condition and 301 died during follow-up. On multivariable analysis for the entire cohort, comorbidity (p = 0.0001), AJCC stage (p = 0.0001), age (p = 0.0001), and race (p = 0.0045) significantly predicted overall survival. On subset analysis of noninvasive bladder cancer patients, comorbidity (p = 0.0001) and age (p = 0.0001) independently predicted overall survival, whereas stage, grade, race, and gender did not. On subset analysis of cystectomy patients, comorbidity (p = 0.0053), stage (p = 0.0001), and race (p = 0.0449) significantly predicted overall survival.Conclusions-Comorbidity is an independent predictor of overall survival in the entire cohort of bladder cancer patients, the subset with noninvasive disease, and the subset treated with cystectomy.

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Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Comorbidity in Patients with Bladder Cancer

Megwalu¹,

Vlahiotis²,

Radwan³

et al. 2008

European Urology

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“…In addition, RC demonstrates a 3-5-fold higher perioperative mortality in septuagenarians (5.4%) and octogenarians (9.2%) in comparison to patients ≤ 69 years (2%) (5). 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: 93%

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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“…Most studies evaluating complications after RC have not used standardized reporting criteria, applied different definition of complications and the length of follow-up after surgery differed significantly [7]. However, regardless of the definition used, studies from high volume centers have reported lower complication rates varying between 0.9-11% [17,18], suggesting that this type of surgery yields better results when performed by high volume surgeons in specialized tertiary care units. Postoperative care is paramount in these cases, since most of the complications are mainly medical, such as bronchopneumonia, deep vein thrombosis/pulmonary thromboembolism, delirium and myocardial infarction [7].…”

Section: Complications After Surgical Treatmentmentioning

confidence: 99%