Radical cystectomy over the age of 75 is safe and increases survival

BMC Geriatrics

Constantinos A Constantinides¹  Dionysios Mitropoulos¹  Ioannis Leotsakos¹  Ioannis Katafigiotis¹  Antonios Balangas³  Anastasios Kollias³  Aristeides Alevizopoulos¹  Konstantinos G Stravodimos¹  Ioannis Anastasiou¹  Stavros I Tyritzis² 

[1] Department of Urology, Athens University Medical School, LAIKO Hospital, Athens, Greece;Department of Urology, Athens University Medical School, LAIKO Hospital, 17 Agiou Thoma str., Athens 11527, Greece;Department of Urology, Ammerland Clinics, Westerstede, Germany

关键词: Charlson comorbidity index;    Clavien classification system;    Survival;    Complications;    Octogenarians;    Radical cystectomy;   

Others  :  858133
DOI  :  10.1186/1471-2318-12-18

 received in 2011-11-22, accepted in 2012-04-30,  发布年份 2012

【 摘 要 】

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.

【 授权许可】

   
2012 Tyritzis et al.; licensee BioMed Central Ltd.

【 图 表 】

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