Cystectomy in the ninth decade: operative results and long-term survival outcomes.

Introduction: Radical cystectomy (RC) with urinary diversion remains as one of the more complex urological procedures despite considerable progress in surgical technique. Increasing patient age, along with associated age-related comorbidities, may portend a poor outcome in those undergoing such complicated surgical procedures. Herein, we report our experience with radical cystectomy in the elderly population.

Methods: We retrospectively reviewed our RC results from 1995 to 2003. Patients >or = 80 years old were included in this analysis. Perioperative outcomes, as well as overall and disease-free survival were evaluated.

Results: A total of 517 patients underwent RC with urinary diversion during this time period. Forty-nine (9.5%) patients were >or= 80 years old. Mean age and BMI were 83.4 years (range 80-94) and 27.1kg/m2 (range 17.4-39.0), respectively. Eighty-three percent of the patients had >or= 1 comorbidities and 67% had a significant smoking history. Mean operative time and estimated blood loss were 279 minutes and 985 ml, respectively. Thirty-two patients (76%) required blood transfusion in the perioperative period. Among patients found to have urothelial cancer a pathological analysis (36), 21 patients (58%) had < pT3a while 15 patients (42%) had >or= pT3b or >or= N1. Intraoperative complications (5%) included one large bowel injury and hypogastric artery laceration. Thirty- and 90-day mortality rates were 9.5% and 11%, respectively. Early and late postoperative complications were 57% and 17% and 5-year overall and disease-free survival were 44% and 36%, respectively.

Conclusions: Radical cystectomy with urinary diversion in patients >or= 80 years old is related with significant short-term and long-term morbidity. Proper patient selection assessing performance status and psychosocial parameters appear to optimize survival outcomes. However, regardless of age, timely surgical management for localized disease control is essential for ultimate sustained disease-free survival.