Radical cystectomy over the age of 75 is safe and increases survival

Stavros I Tyritzis,Ioannis Katafigiotis,Ioannis Leotsakos,Dionysios Mitropoulos,Antonios Balangas,Ioannis Anastasiou,Constantinos A Constantinides,Anastasios Kollias,Konstantinos G Stravodimos,Aristeides Alevizopoulos

doi:10.1186/1471-2318-12-18

Stavros I Tyritzis, Ioannis Katafigiotis + Show 8 more

Open Access

https://doi.org/10.1186/1471-2318-12-18

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Abstract

BackgroundRadical cystectomy (RC) is probably underused in elderly patients due to a potential increased postoperative complication risk, as reflected by their considerable comorbidities. Our objective was to estimate the overall complication rate and investigate a potential benefit to patients over the age of 75 subjected to RC in terms of disease-free survival.MethodsA total of 81 patients, 61 men and 20 women, from two urological departments, with a mean age of 79.2 ± 3.7 years, participated in the study. The mean follow-up period was 2.6 ± 1.6 years. All patients underwent RC with pelvic lymphadenectomy. An ileal conduit, an orthotopic ileal neobladder and cutaneous ureterostomies were formed in 48.1%, 6.2% and 45.7% of the patients, respectively. The perioperative and 90-day postoperative complications were recorded and classified according to the modified Clavien classification system. Survival plots were created based on the oncological outcome and several study parameters.ResultsThe perioperative morbidity rate was 43.2%; the 90-day morbidity rate was 37%, while the 30-day, 90-day and overall mortality rates were 3.7%, 3.7% and 21%, respectively. Overall mortality rates were recorded at the final year of data gathering (2009). Increased age, increased body mass index (BMI), longer hospitalization and age-adjusted Charlson comorbidity index (ACCI) more than six, were associated with greater hazard for 90-day morbidity. The cumulative mortality / metastasis-free rates for one, two, three and five years were 88.7%, 77.5%, 70.4%, and 62.3%, respectively. Tumour stage and positive nodes were prognostic predictors for oncological outcome.ConclusionsRC in patients over 75 is justified and feasible, due to acceptable complication rates and high 5-year cancer-specific survival, which support an aggressive approach. Prospective studies are needed for the verification of the above results.

Highlights

Radical cystectomy (RC) is probably underused in elderly patients due to a potential increased postoperative complication risk, as reflected by their considerable comorbidities
Even though radical cystectomy (RC) is the gold standard for this disease [3], it is underused and possibly inappropriately denied, because the majority of these patients are either unfit for surgery or have considerable comorbidities
Increased surgical experience and improvements in surgical techniques are constantly expanding the indications for aggressive treatment. This fact provided the rationale for our study, which attempted to investigate the feasibility of RC in these high-risk patients and establish a potential benefit on cancer-specific survival in the long term

Summary

Introduction

Radical cystectomy (RC) is probably underused in elderly patients due to a potential increased postoperative complication risk, as reflected by their considerable comorbidities. Even though radical cystectomy (RC) is the gold standard for this disease [3], it is underused and possibly inappropriately denied, because the majority of these patients are either unfit for surgery or have considerable comorbidities. Increased surgical experience and improvements in surgical techniques are constantly expanding the indications for aggressive treatment This fact provided the rationale for our study, which attempted to investigate the feasibility of RC in these high-risk patients and establish a potential benefit on cancer-specific survival in the long term

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Conclusion