Surgical management of infiltrating bladder cancer in elderly patients.
OBJECTIVE
To review the surgical therapeutic options in elderly patients with infiltrating bladder cancer.


METHODS
A review of the literature relevant to cystectomy and transurethral resection for infiltrating bladder cancer in elderly patients was conducted using Medline Services.


RESULTS
Thanks to progress in anaesthesia, intensive care and surgery, cystectomy now forms part of the classical treatments for bladder cancer in elderly patients, with acceptable mortality and morbidity rates. The recent series of cystectomies performed in patients over 75 years old report a mortality rate associated with the procedure of less than 4.5%. The global mortality rate in the same population ranges from 10 to 50%. These rates are now similar to those reported in the general population. The mean survival after cystectomy in patients over 75 years old is more than 2 years. Global survival at 5 years is between 37 and 68%. It is acknowledged by most authors that resection alone is associated with higher relapse and progression rates than cystectomy.


CONCLUSIONS
Cystectomy appears to be reasonable in elderly people who have a life expectancy of more than 2 years, provided that a rigorous pre-operative assessment and anaesthetic management are performed. Transurethral resection alone should be proposed only to patients with poor health status and/or very advanced age.
Peyromaure
Michaël
M
Department of Urology, Cochin Hospital, 27 rue du Faubourg Saint Jacques, 75014 Paris, France. michael.peyromaure@cch.ap-hop-paris.fr
Guerin
Florent
F
Debre
Bernard
B
Zerbib
Marc
M
D000367:Age Factors; D000368:Aged; D003422:Critical Care; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods