title: Radical cystectomy in octogenarians--does morbidity outweigh the potential survival benefits?
abstract: OBJECTIVE
  Surveillance, Epidemiology, and End Results data indicate only 19.7% of patients 80 years old or older with muscle invasive bladder cancer undergo radical cystectomy vs 49.4% of those with similar stage disease age 65 to 79 years, reflecting concern for perioperative morbidity. We evaluated the morbidity and survival outcomes of octogenarians treated with radical cystectomy at a tertiary cancer center.
  
  
  METHODS
  We conducted a retrospective review of 1,142 patients entered prospectively into a hospital based complication database between 1995 and 2005 using a modified Clavien system. Complications were classified as minor or major based on the complexity of intervention required. Disease specific and competing risk survival curves for patients younger than 80 years vs 80 years old or older were created.
  
  
  RESULTS
  Octogenarians had a nonsignificantly higher rate of minor (55% vs 50%) and major complications (17% vs 13%) than younger patients, respectively (global p = 0.15). After adjusting for baseline characteristics the risk of any complication was roughly flat across all ages (p = 0.9). For major complications risk appeared to increase slightly up to age 65 years and then plateau (p = 0.16). After adjusting for deaths from other causes the cumulative incidence of death from bladder cancer in octogenarians was comparable to that in younger patients (5-year cumulative incidence of death from bladder cancer 26% vs 25%).
  
  
  CONCLUSIONS
  In our experience radical cystectomy in older patients with bladder cancer provides similar disease control and survival outcomes with risks of high grade perioperative morbidity comparable to those in younger patients, and remains an important treatment option.
authors.affiliation: Department of Urology, the Genitourinary Oncology Service in the Department of Medicine (MIM), and the Department of Epidemiology and Biostatistics (AC), Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. donats@mskcc.org
authors.forename: S Machele
authors.initials: SM
authors.lastname: Donat
authors.forename: Timothy
authors.initials: T
authors.lastname: Siegrist
authors.forename: Angel
authors.initials: A
authors.lastname: Cronin
authors.forename: Caroline
authors.initials: C
authors.lastname: Savage
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Milowsky
authors.forename: Harry W
authors.initials: HW
authors.lastname: Herr
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000601:surgery*