title: Older patients suffer from adverse histopathological features after radical cystectomy.
abstract: OBJECTIVE
  Radical cystectomy (RC) remains a complex procedure in older patients. Perioperative morbidity can be significant and it can represent a limitation for its indication in this population. The aim of the present study was to evaluate the outcomes of RC in elderly patients from a large single-center cohort.
  
  
  METHODS
  A total of 447 patients who underwent RC between 1996 and 2009 at our institution were considered. Patients were stratified by age (≤70 vs >70 years). Logistic regression analyses were carried out comparing both groups regarding clinical, perioperative and histopathological findings, as well as complications according to the modified Clavien system and survival.
  
  
  RESULTS
  Data of 390 patients were available for the analysis. Of these, 265 (67.9%) versus 125 (32.1%) patients were <70 versus ≥70 years-of-age. The median age was 61 and 75 years, respectively. In the elderly, ASA score (P < 0.001), delay between transurethral resection of the bladder (TURBT) and RC (P = 0.004), and number of perioperative blood transfusions (P = 0.002) were significantly higher. Additionally, a clear trend towards higher stages (pT3-4) was observed (P = 0.04). However, complications, and overall and cancer-specific mortality were not increased in older patients. Finally, age was identified as a significant risk factor for upstaging (P = 0.04). Upstaging between TURBT and final histopathology in patients <70 versus ≥70 years occurred in 45% versus 58%, respectively (P = 0.03).
  
  
  CONCLUSIONS
  RC is equally feasible in older patients without increasing morbidity or mortality. On the contrary, older patients have a higher risk of significant upstaging and advanced stages at final histopathology. These findings suggest that RC should neither be delayed in nor withheld from elderly patients.
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. mrink@uke.unihamburg.de
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.forename: Roland
authors.initials: R
authors.lastname: Dahlem
authors.forename: Luis
authors.initials: L
authors.lastname: Kluth
authors.forename: Sarah
authors.initials: S
authors.lastname: Minner
authors.forename: Sascha A
authors.initials: SA
authors.lastname: Ahyai
authors.forename: Christian
authors.initials: C
authors.lastname: Eichelberg
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.forename: Felix Kh
authors.initials: FKh
authors.lastname: Chun
mesh_terms: D000367:Age Factors; D000368:Aged; D015653:Cystectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*