Perioperative complications and 90-day mortality of radical cystectomy in the elderly (75+): a retrospective, multicentre study

Ingrid Berger, Thomas Martini, Clemens Wehrberger, Eva Comploj, Anton Ponholzer, Martina Wolfgang, Eckart Breinl, Michael Dunzinger, Johann Hofbauer, Wolfgang Höltl, Klaus Jeschke, Steffen Krause, Walter Kugler, Walter Pauer, Michael Rauchenwald, Armin Pycha, Stephan Madersbacher

Research output: Journal article (peer-reviewed)Journal article

29 Citations (Scopus)

Abstract

OBJECTIVE: To assess perioperative complications and 90-day mortality of radical cystectomy (RC) in elderly patients with muscle-invasive bladder cancer (MIBC).

MATERIALS AND METHODS: This is a retrospective, multicentre (n = 11) study of a consecutive series of patients ≥75 years who underwent RC for MIBC between 2006 and 2010. Medical, surgical and wound complications were graded according to the modified Clavien-Dindo classification.

RESULTS: A total of 256 patients with a mean age of 79.6 years (range 75.0-86.6) were analysed. Urinary diversion with the use of bowel was performed in 79.5% and ureterocutaneostomy in 20.5%, with a higher proportion in the ≥80 cohort (32.2 vs. 14%; p = 0.001). 41.4% of patients had an uneventful postoperative course (Clavien grade 0) and 26.6% developed severe complications (Clavien grade III-V). In a multivariable regression analysis, the Charlson comorbidity index (odds ratio 1.5 per unit increase; p < 0.001) and the body mass index (odds ratio 1.13 per kg/m(2) increase; p = 0.015) were predictors for the development of complications. The 90-day mortality rate was 9% and the independent correlates thereof were the development of severe medical complications (p = 0.004), the American Society of Anesthesiologists (ASA) score (p = 0.03) and age (p = 0.005).

CONCLUSIONS: Morbidity and 90-day mortality of RC in the elderly remain substantial. The interrelation between comorbidity, complication rate and 90-day mortality underlines the need for a comprehensive geriatric assessment of elderly patients with MIBC in whom RC is indicated.

Original languageEnglish
Pages (from-to)296-302
Number of pages7
JournalUrologia Internationalis
Volume93
Issue number3
DOIs
Publication statusPublished - 7 Nov 2014

Keywords

  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Cystectomy/adverse effects
  • Female
  • Humans
  • Male
  • Muscles/pathology
  • Perioperative Period
  • Prognosis
  • Retrospective Studies
  • Treatment Outcome
  • Urinary Bladder Neoplasms/diagnosis
  • Urinary Diversion
  • Wound Healing

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