EDITORIAL COMMENT

Abstract

Radical cystectomy (RC) is the standard of care for muscle-invasive and highest risk nonmuscle-invasive bladder cancer although is often burdened by a high rate of perioperative complications and a non-negligible mortality rate. 1 Mari A Campi R Tellini R et al. Patterns and predictors of recurrence after open radical cystectomy for bladder cancer: a comprehensive review of the literature. World J Urol. 2017; 36: 157-170https://doi.org/10.1007/s00345-017-2115-4 Crossref Scopus (69) Google Scholar , 2 Witjes JA Comperat E Cowan NC et al. EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol. 2014; 65: 778-792https://doi.org/10.1016/j.eururo.2013.11.046 Abstract Full Text Full Text PDF PubMed Scopus (779) Google Scholar In this study, the authors aimed to evaluate the impact of frailty, assessed through a claims-based frailty index extracting data from the US NRD, on perioperative outcomes of RC. More than 7% of patients were considered frail at time of surgery and frailty status was the strongest predictor of ICU-level complications as well as it was associated with a more than 2-fold increase of in-hospital mortality. Frailty was the main determinant of nonhome discharge and increased hospital costs, while, notably, medical comorbidity burden was not an independent predictor of frailty status. Therefore, frailty assessment is pivotal for an adequate risk stratification and preoperative counseling since comorbidity index, age and American Society of Anesthesiologists physical status classification alone seem not to be adequate. 3 Psutka SP Barocas DA Catto JWF et al. Staging the host: personalizing risk assessment for radical cystectomy patients. Eur Urol Oncol. 2018; 1: 292-304https://doi.org/10.1016/j.euo.2018.05.010 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar