Radical cystectomy in the elderly patient: a contemporary comparison of perioperative complications in a single institution series.
OBJECTIVE
To report on our recent experience with peri- and postoperative morbidity of radical cystectomy in patients 75 years and older compared to younger patients.


METHODS
Medical records of 326 consecutive patients undergoing radical cystectomy from May 2004 through April 2008 were reviewed.


RESULTS
Eighty-five of 326 patients (26%) were > or =75 years (75-95) old. ASA score was equal 3 or greater in 51% of patients > or =75 years and 32% of patients <75 years. Ileal conduit was performed in 83% of patients > or =75, 16% received an ileal neobladder compared to 46 and 51%, respectively, in patients <75. A total of 33 patients (39%) in the older patient group received blood transfusions intraoperatively compared to 76 patients (32%) in the younger age group. In 6 patients > or =75 years (7.1%) and 17 patients <75 (7.1%) open surgical revision was necessary, perioperative complication rate was 22 and 21%, respectively. The most common complications were wound dehiscence (5.9 vs. 7.5%), infections (4.7 vs. 4.6%), and pulmonary embolism (3.5 vs. 2.1%). Perioperative mortality was 1.2% (1 patient) in the elderly versus 0.4% (1 patient) in the younger age group.


CONCLUSIONS
Our data show that radical cystectomy can be offered to the elderly patient with acceptable morbidity. Because of higher comorbidity rate in the elderly, therapeutic decision for radical cystectomy in elderly patients should be made carefully and individually. Nevertheless our results demonstrate that age itself is not a main criterion which has to be considered strongly in decision making for radical cystectomy.
Department of Urology, Ludwig-Maximilians-University Munich, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany. Derya.Tilki@med.uni-muenchen.de
Derya
D
Tilki
Dirk
D
Zaak
Matthias
M
Trottmann
Alexander
A
Buchner
Yeliz
Y
Ekiz
Niklas
N
Gerwens
Boris
B
Schlenker
Alexander
A
Karl
Sebastian
S
Walther
Patrick J
PJ
Bastian
Christian
C
Gratzke
Stefan
S
Tritschler
Ruth
R
Knüchel-Clarke
Süleyman
S
Ergün
Christian G
CG
Stief
Oliver
O
Reich
Michael
M
Seitz
D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D009017:Morbidity; D009367:Neoplasm Staging / Q000706:statistics & numerical data; D018358:Neuroendocrine Tumors / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D017063:Outcome Assessment, Health Care; D012086:Reoperation / Q000706:statistics & numerical data; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*