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Logo of bmcgeriBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Geriatrics
 
BMC Geriatr. 2012; 12: 18.
Published online Apr 30, 2012. doi:  10.1186/1471-2318-12-18
PMCID: PMC3419099
Radical cystectomy over the age of 75 is safe and increases survival
Stavros I Tyritzis,corresponding author1,3 Ioannis Anastasiou,1 Konstantinos G Stravodimos,1 Aristeides Alevizopoulos,1 Anastasios Kollias,2 Antonios Balangas,2 Ioannis Katafigiotis,1 Ioannis Leotsakos,1 Dionysios Mitropoulos,1 and Constantinos A Constantinides1
1Department of Urology, Athens University Medical School, LAIKO Hospital, Athens, Greece
2Department of Urology, Ammerland Clinics, Westerstede, Germany
3Department of Urology, Athens University Medical School, LAIKO Hospital, 17 Agiou Thoma str., Athens 11527, Greece
corresponding authorCorresponding author.
Stavros I Tyritzis: styritzis/at/med.uoa.gr; Ioannis Anastasiou: ekati2/at/otenet.gr; Konstantinos G Stravodimos: kgstravod/at/yahoo.com; Aristeides Alevizopoulos: aris_alev/at/gmail.com; Anastasios Kollias: akollias/at/ammerland-klinik.de; Antonios Balangas: abalangas/at/yahoo.com; Ioannis Katafigiotis: katafigiotis/at/yahoo.com; Ioannis Leotsakos: leotsakos/at/yahoo.com; Dionysios Mitropoulos: dmp/at/otenet.gr; Constantinos A Constantinides: ckonstan/at/med.uoa.gr
Received November 22, 2011; Accepted April 30, 2012.
Abstract
Background
Radical cystectomy (RC) is probably underused in elderly patients due to a potential increased postoperative complication risk, as reflected by their considerable comorbidities. Our objective was to estimate the overall complication rate and investigate a potential benefit to patients over the age of 75 subjected to RC in terms of disease-free survival.
Methods
A total of 81 patients, 61 men and 20 women, from two urological departments, with a mean age of 79.2 ± 3.7 years, participated in the study. The mean follow-up period was 2.6 ± 1.6 years. All patients underwent RC with pelvic lymphadenectomy. An ileal conduit, an orthotopic ileal neobladder and cutaneous ureterostomies were formed in 48.1%, 6.2% and 45.7% of the patients, respectively. The perioperative and 90-day postoperative complications were recorded and classified according to the modified Clavien classification system. Survival plots were created based on the oncological outcome and several study parameters.
Results
The perioperative morbidity rate was 43.2%; the 90-day morbidity rate was 37%, while the 30-day, 90-day and overall mortality rates were 3.7%, 3.7% and 21%, respectively. Overall mortality rates were recorded at the final year of data gathering (2009). Increased age, increased body mass index (BMI), longer hospitalization and age-adjusted Charlson comorbidity index (ACCI) more than six, were associated with greater hazard for 90-day morbidity. The cumulative mortality / metastasis-free rates for one, two, three and five years were 88.7%, 77.5%, 70.4%, and 62.3%, respectively. Tumour stage and positive nodes were prognostic predictors for oncological outcome.
Conclusions
RC in patients over 75 is justified and feasible, due to acceptable complication rates and high 5-year cancer-specific survival, which support an aggressive approach. Prospective studies are needed for the verification of the above results.
Keywords: Radical cystectomy, Octogenarians, Complications, Survival, Clavien classification system, Charlson comorbidity index
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