Laparoscopic radical cystectomy in octogenarians: analysis of a Japanese multicenter cohort.

Abstract

This study aimed to describe the morbidity and mortality in older patients undergoing laparoscopic radical cystectomy (LRC) and compare the outcomes of LRC between octogenarians and younger patients (< 80years) in a Japanese multicenter cohort. We identified 433 patients (80 octogenarians) who underwent LRC in a retrospective multicenter database from 10 institutions. The perioperative outcomes and the 90-day and late (> 90-day) complications according to the Clavien-Dindo classification were compared between the octogenarians and younger patients. Recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS) were measured by the Kaplan-Meier method. Compared with the younger group, the octogenarian group included a significantly higher proportion of women, patients with a lower body mass index, patients with a lower preoperative albumin level, and patients with a history of abdominal surgery. The 90-day rates of all complications and major complications (grades III-V) were 50.0% and 20.0% among octogenarians and 54.7% and 16.4% among younger patients. The 90-day mortality rate among octogenarians was 3.8%. The 2-year RFS, CSS, and OS rates for octogenarians stratified by pathological stage was 95.2, 100, and 100% for ≤ pT1; 50.7, 76.6, and 56.1% for pT2; 33.6, 82.5, and 72.6% for ≥ pT3; and 23.1, 42.2, and 37.5% for pN + or distant metastasis, respectively. There was significant difference between octogenarians and younger patients only in 2-year OS for pT2 (56.1% vs 87.7%, p = 0.03). This study revealed that LRC can be performed for selected octogenarians with a complication rate similar to that of younger patients. Appropriate risk evaluation and modification of surgical procedures are necessary for octogenarians.