Major invasive surgery for urologic cancer in octogenarians with comorbid medical conditions.
OBJECTIVE
We retrospectively reviewed the records of the octogenarian patients who underwent major surgery for urologic cancer at two institutions. The aims of our study were to assess intra- and postoperative morbidity and mortality rates, and to identify potential risk factors that can predict postoperative complications and, as a consequence, surgical outcome.


METHODS
Fifty-five patients (median age: 83 yr) underwent major surgery for urologic cancer. Radical nephrectomy was performed in 27 patients, radical cystectomy with urinary diversion was done in 20 patients, and nephroureterectomy was performed in the remainder. Significant comorbidity was present in 51 patients.


RESULTS
The perioperative mortality rate was 9%. The overall mortality rate was 69%; cancer-specific mortality was 28%. Intraoperative complications occurred in 11% of patients. Postoperative intensive care monitoring was required in 29% of patients. The early postoperative complication rate was 33%. Only the presence of more than two comorbidities (p<0.05) and chronic obstructive lung disease (COLD) (p=0.017) resulted in independent prognostic factors for morbidity. Sixteen percent of patients developed a late postoperative complication within the first 6 mo. Median hospital stay was 14 d (range: 6-55), and hospital stays were significantly longer among patients with complications (p<0.05). The 3-yr and 5-yr overall survival rates were 36% and 26%, respectively; these rates were significantly lower in patients with COLD (p<0.01). There was no significant difference between cancer-specific and non-cancer-specific survival rates.


CONCLUSIONS
Major surgery for urologic malignancies can be safely performed in selected octogenarian patients.
Liguori
Giovanni
G
Department of Urology, University of Trieste, Trieste, and S. Chiara Hospital, Pisa, Italy. gioliguori@libero.it
Trombetta
Carlo
C
Pomara
Giorgio
G
Amodeo
Antonio
A
Bucci
Stefano
S
Garaffa
Giulio
G
Francesca
Francesco
F
Belgrano
Emanuele
E
D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009392:Nephrectomy / Q000379:methods; D011183:Postoperative Complications; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods; D014571:Urologic Neoplasms / Q000601:surgery*