Radical cystectomy in the elderly: comparison of clincal outcomes between younger and older patients.
BACKGROUND
The authors report their experience with radical cystectomy for transitional cell carcinoma (TCC) of the bladder comparing clinical outcomes, including complication rates, among older patients versus younger patients in a high-volume center specializing in the treatment of patients with advanced carcinoma of the urinary bladder.


METHODS
A retrospective review was undertaken of 1054 patients who underwent radical cystectomy for bladder TCC from 1971 through 1997. Four age groups were compared; < 60 years at the time of cystectomy (n = 309 patients), age 60-69 years (n = 381 patients), age 70-79 years (n = 314 patients), and age > or = 80 years (n = 50 patients).


RESULTS
The median length of hospital stay in patients ages < 60 years, 60-69 years, 70-79 years, and > or = 80 years was 10 days, 10 days, 11 days, and 11 days, respectively (P < 0.001). The corresponding rates of overall early complications were 24%, 25%, 37%, and 30%, respectively (P = 0.002); whereas the corresponding late complication rates were 36%, 30%, 22%, and 14%, respectively (P < 0.001). The rate of early diversion-related complications did not differ significantly (11%, 8%, 12%, and 6%, respectively; P = 0.14). The operative mortality rates were 1%, 3%, 4%, and 0%, respectively (P = 0.14). There was no difference with respect to early complications, early diversion-related complications, late complications, or operative mortality comparing patients age > 70 years who underwent ileal conduit versus orthotopic urinary diversion (P = 0.20, P = 0.61, P = 0.53, and P = 0.78, respectively).


CONCLUSIONS
Elderly patients who underwent cystectomy for TCC had similar mortality and early diversion-related complication rates. Carefully selected elderly patients safely can be offered an orthotopic urinary diversion. Chronological age, per se, is not a contraindication for radical cystectomy in the setting of invasive bladder carcinoma.
Clark
Peter E
PE
Department of Urology, Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157, USA. peclark@wfubmc.edu
Stein
John P
JP
Groshen
Susan G
SG
Cai
Jie
J
Miranda
Gus
G
Lieskovsky
Gary
G
Skinner
Donald G
DG
D000367:Age Factors; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*; D014547:Urinary Diversion