Treatment of Bladder Carcinoma in Patients More than 80 Years Old

Abstract

We reviewed 26 patients more than 80 years old with bladder carcinoma to determine if an active surgical policy is justified. Ten patients with superficial carcinoma were treated with transurethral resection; none died of cancer and half have survived 5 years. Of 16 patients with invasive carcinoma 9 underwent total cystectomy with urinary diversion and 2 underwent partial cystectomy. There was no operative mortality. Postoperative complications were not serious. Five of the 9 patients who underwent total cystectomy are alive, with a mean survival of 35 months. The 4-year crude survival rate was 50 per cent. Both patients who underwent partial cystectomy died within 2 years. One patient treated with radiotherapy alone and 1 without any treatment have survived 2 years. These results suggest that contrary to the general tendency towards conservative treatment, a curative operation is worth attempting in elderly patients with bladder carcinoma.

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

“…In fact, complication rates of these studies have extremely varied from 7.7% to 67.0% [8][9][10][11][12][13][14][15][16][17][18]. In this series, the early and late postoperative complication rates in patients aged ‡80 years were 30.6% and 20.8%, respectively, and these outcomes were not significantly different from those in patients aged <80 years.…”

“…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.…”

“…Generally, several investigators concluded that radical cystectomy could be safely performed in properly selected elderly patients; however, the mortality rates in this population have varied from 0% to 18% with overall mortality rates of 4% [8][9][10][11][12][13][14][15][16][17][18]. In this series, 3 of the 72 patients aged ‡80 years died within the first 30 days after surgery; therefore, the perioperative mortality rate of this group was 4.2%, which is similar to that in the literature.…”

“…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.…”

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

“…Previous studies have shown that RC in patients >75 years could be safely performed with acceptable perioperative morbidity [18][19][20][21]. When examining surgical series including only patients aged >80 years, perioperative complication rates range from 11 to 67% [18].…”