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Perioperative complications and 90-day mortality of radical cystectomy in the elderly (75+): a retrospective, multicentre study

Urol Int. 2014;93(3):296-302.

Urol Int. 2014;93(3):296-302.

Abstract

OBJECTIVE:

To assess perioperative complications and 90-day mortality of radical cystectomy (RC) in elderly patients with muscle-invasive bladder cancer (MIBC).

MATERIALS AND METHODS:

This is a retrospective, multicentre (n = 11) study of a consecutive series of patients ≥75 years who underwent RC for MIBC between 2006 and 2010. Medical, surgical and wound complications were graded according to the modified Clavien-Dindo classification.

RESULTS:

A total of 256 patients with a mean age of 79.6 years (range 75.0-86.6) were analysed. Urinary diversion with the use of bowel was performed in 79.5% and ureterocutaneostomy in 20.5%, with a higher proportion in the ≥80 cohort (32.2 vs. 14%; p = 0.001). 41.4% of patients had an uneventful postoperative course (Clavien grade 0) and 26.6% developed severe complications (Clavien grade III-V). In a multivariable regression analysis, the Charlson comorbidity index (odds ratio 1.5 per unit increase; p < 0.001) and the body mass index (odds ratio 1.13 per kg/m(2) increase; p = 0.015) were predictors for the development of complications. The 90-day mortality rate was 9% and the independent correlates thereof were the development of severe medical complications (p = 0.004), the American Society of Anesthesiologists (ASA) score (p = 0.03) and age (p = 0.005).

CONCLUSIONS:

Morbidity and 90-day mortality of RC in the elderly remain substantial. The interrelation between comorbidity, complication rate and 90-day mortality underlines the need for a comprehensive geriatric assessment of elderly patients with MIBC in whom RC is indicated.

2014 S. Karger AG, Basel.

Comment from Maria Ribal: Chronological age is of limited relevance in order to indicate radical cystectomy for bladder cancer. The decision regarding bladder-sparing or radical cystectomy in elderly/geriatric patients with invasive bladder cancer should be based on tumour stage and comorbidity best quantified by a validated score, such as the Charlson Comorbidity Index, as it is already recommended in current EAU Muscle-Invasive Bladder Cancer Guidelines. In this paper Berger et al reviewed a multicentre consecutive series of patients older than 75 submitted to radical cystectomy for MIBC. In a multivariable regression analysis, the Charlson comorbidity index and the body mass index were predictors for the development of complications. The authors stressed the role of a comprehensive geriatric assessment of elderly patients before radical cystectomy is recommended.