title: Radical cystectomy in octogenarian patients: a difficult decision to take.
abstract: BACKGROUND
  The increasing life expectancy and the proportion of octogenarians make radical cystectomy (RC) more frequent in octogenarian patients with muscle invasive bladder cancer.
  
  
  OBJECTIVE
  To analyze overall survival and complications in our series.
  
  
  METHODS
  Descriptive analysis of patients older than 80 years undergoing RC between 2000 and 2012. Surgical risk (American Society of Anesthesiologists scale, ASA), hospital stay, complications (Clavien-Dindo classification) and types of urinary diversion were evaluated. Variables were expressed in mean or medians. Overall survival was analyzed using the Kaplan-Meier method. Univariate overall survival analysis was performed using the univariate Cox regression model. The null hypothesis was rejected by a type I error <0.05. Statistical analyses were performed using SPSS 15.0 (SPSS Inc., Chicago, Ill., USA).
  
  
  RESULTS
  Thirty-three patients were included. Their mean age was 81.9 ± 1.8 years. There were 24 males (72.7%). The surgical risk was identified as follows: ASA II in 9 patients (27.3%), ASA III in 23 (69.7%) and ASA IV in 1 (3%). Concerning urinary diversion, 19 patients (57.6%) underwent ureteroileostomy and 14 (42.4%) bilateral cutaneous ureterostomy. Average hospital length of stay was 19 days (14-30). TNM stage was T0 in 1 patient (3%), T1 in 4 (12.1%), T2 in 11 (33.3%), T3 in 13 (39.4%), T4 in 4 (12.1%), Nx in 9 (12%), N0 in 13 (39.4%), N1 in 3 (9.1%), and N2 in 5 (15.2%). The most frequent complications were pneumonia in 6 patients (18.2%) and surgical wound infection in 6 (18.2%). Lymphadenectomy did not involve a significant increase in complications. Six patients (18.2%) died in the immediate postoperative period, 5 of whom from respiratory complications. The mean survival of the rest of the series was 24 months (range 15.1-32.8).
  
  
  CONCLUSIONS
  Overall assessment of the patient is essential and not only the chronological age. RC is a valid option despite chronological age. In the postoperative period, there is a higher risk of complications but not higher mortality due to surgical complications.
authors: Clinico San Carlos Hospital, Madrid, Spain.
authors: Hector
authors: H
authors: Garde
authors: Marco
authors: M
authors: Ciappara
authors: Isabel
authors: I
authors: Galante
authors: Manuel
authors: M
authors: Fuentes Ferrer
authors: Angel
authors: A
authors: Gómez
authors: Jesus
authors: J
authors: Blazquez
authors: Jesus
authors: J
authors: Moreno
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D009367:Neoplasm Staging; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion