Radical Cystectomy Is Safe in Elderly Patients at High Risk

Abstract

Our results support the safety of radical cystectomy in elderly patients at high risk. Acceptable perioperative morbidity and mortality may be achieved without routine intensive monitoring postoperatively.

Significance of radical cystectomy for bladder cancer in patients over 80 years old

“…In elderly patients as well, several investigators have shown that radical cystectomy could be safely performed with acceptable perioperative morbidity and mortality, if candidates for this aggressive surgery were properly selected [8][9][10][11][12][13][14][15][16][17][18]. However, there are some problems in these studies that remain to be elucidated as follows: (1) The definition of elderly has varied in each study, and there are only six series analyzing patients aged ‡80 years undergoing radical cystectomy.…”

“…In most of the previous studies, patients aged ‡70 or 75 years were defined as elderly [8][9][10][11][12]; however, in this series, we defined elderly patients as those aged ‡80 years in order to more specifically characterize the features of elderly patients treated with radical cystectomy and urinary diversion. Using this criterion, there were 72 elderly patients among 629 patients undergoing radical cystectomy at our institutions.…”

“…However, considering the aggressive characteristics of untreated or under-treated invasive bladder cancer which may rapidly progress to fatality within a short period, performing a definitive therapy for patients with invasive disease would be strongly advocated irrespective of patient age. Although several investigators have reported the outcomes of radical cystectomy performed for elderly patients [8][9][10][11][12], to our knowledge, only six studies focussed on the octogenarian population, and all of these studies included a small number of patients (median number of patients, 14; range, [13][14][15][16][17][18]. Accordingly, in this study, we retrospectively reviewed our experience with radical cystectomy for bladder cancer in 72 patients aged ‡80 years to clarify whether this procedure could be an optimal therapeutic strategy for such elderly patients who require definitive treatment for locally invasive disease.…”

Radical cystectomy in septuagenarian patients with bladder cancer

“…Intensive chest physiotherapy, bronchodilators, effective bowel preparation with intravenous fluids to avoid dehydration, expeditious surgery with careful attention to surgical technique, intensive monitoring and early mobilization of the patient are some of the measure that have been helpful in avoiding complications in our patients. In a selected group of high-risk patients, admission to intensive care units for additional evaluation and monitoring may be indicated [8,24]. No routine use of digitalis [9,10,25] or anticoagulation [10,24,25] as advocated by few were done.…”

Geriatrisches Assessment

“…Während es in 3 dieser Serien [20,21,22] zu keinen Todesfällen kam, starben in den beiden anderen Serien [23,24] [20,28]. Die Rate an Spätkomplikationen variierte in den genannten 5 Serien zwischen 6 und 52% [20,21,22,23,24]. Hier standen chirurgische Komplikationen im Vordergrund, wobei eine Ileussymptomatik, Narbenhernien und Inkontinenz nach Blasenersatz am häufigsten waren.…”