Radical cystectomy in octogenarian patients: a difficult decision to take

Abstract

Introduction: The increasing life expectancy and the proportion of octogenarians make radical cystectomy (RC) more frequent in octogenarian patients with muscle invasive bladder cancer.

Objective: To analyze overall survival and complications in our series.

Material and methods: Descriptive analysis of patients older than 80 years undergoing RC between 2000 and 2012. Surgical risk (American Society of Anesthesiologists scale, ASA), hospital stay, complications (Clavien-Dindo classification) and types of urinary diversion were evaluated. Variables were expressed in mean or medians. Overall survival was analyzed using the Kaplan-Meier method. Univariate overall survival analysis was performed using the univariate Cox regression model. The null hypothesis was rejected by a type I error <0.05. Statistical analyses were performed using SPSS 15.0 (SPSS Inc., Chicago, Ill., USA).

Results: Thirty-three patients were included. Their mean age was 81.9 ± 1.8 years. There were 24 males (72.7%). The surgical risk was identified as follows: ASA II in 9 patients (27.3%), ASA III in 23 (69.7%) and ASA IV in 1 (3%). Concerning urinary diversion, 19 patients (57.6%) underwent ureteroileostomy and 14 (42.4%) bilateral cutaneous ureterostomy. Average hospital length of stay was 19 days (14-30). TNM stage was T0 in 1 patient (3%), T1 in 4 (12.1%), T2 in 11 (33.3%), T3 in 13 (39.4%), T4 in 4 (12.1%), Nx in 9 (12%), N0 in 13 (39.4%), N1 in 3 (9.1%), and N2 in 5 (15.2%). The most frequent complications were pneumonia in 6 patients (18.2%) and surgical wound infection in 6 (18.2%). Lymphadenectomy did not involve a significant increase in complications. Six patients (18.2%) died in the immediate postoperative period, 5 of whom from respiratory complications. The mean survival of the rest of the series was 24 months (range 15.1-32.8).

Conclusions: Overall assessment of the patient is essential and not only the chronological age. RC is a valid option despite chronological age. In the postoperative period, there is a higher risk of complications but not higher mortality due to surgical complications.