title: Radical cystectomy in the elderly: comparison of clincal outcomes between younger and older patients.
abstract: 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.
authors.affiliation: Department of Urology, Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157, USA. peclark@wfubmc.edu
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
authors.forename: John P
authors.initials: JP
authors.lastname: Stein
authors.forename: Susan G
authors.initials: SG
authors.lastname: Groshen
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.forename: Gary
authors.initials: G
authors.lastname: Lieskovsky
authors.forename: Donald G
authors.initials: DG
authors.lastname: Skinner
mesh_terms: 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