Laparoscopic radical cystectomy in octogenarians: analysis of a Japanese multicenter cohort
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This study aimed to describe the morbidity and mortality in older patients undergoing laparoscopic radical cystectomy (LRC) and compare the outcomes of LRC between octogenarians and younger patients (< 80 years) in a Japanese multicenter cohort.
We identified 433 patients (80 octogenarians) who underwent LRC in a retrospective multicenter database from 10 institutions. The perioperative outcomes and the 90-day and late (> 90-day) complications according to the Clavien–Dindo classification were compared between the octogenarians and younger patients. Recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS) were measured by the Kaplan–Meier method.
Compared with the younger group, the octogenarian group included a significantly higher proportion of women, patients with a lower body mass index, patients with a lower preoperative albumin level, and patients with a history of abdominal surgery. The 90-day rates of all complications and major complications (grades III–V) were 50.0% and 20.0% among octogenarians and 54.7% and 16.4% among younger patients. The 90-day mortality rate among octogenarians was 3.8%. The 2-year RFS, CSS, and OS rates for octogenarians stratified by pathological stage was 95.2, 100, and 100% for ≤ pT1; 50.7, 76.6, and 56.1% for pT2; 33.6, 82.5, and 72.6% for ≥ pT3; and 23.1, 42.2, and 37.5% for pN + or distant metastasis, respectively. There was significant difference between octogenarians and younger patients only in 2-year OS for pT2 (56.1% vs 87.7%, p = 0.03).
This study revealed that LRC can be performed for selected octogenarians with a complication rate similar to that of younger patients. Appropriate risk evaluation and modification of surgical procedures are necessary for octogenarians.
KeywordsBladder cancer Complication Laparoscopy Radical cystectomy Elderly Octogenarians
The authors wish to acknowledge the assistance of the following individuals in this study: Kazuhiro Okumura, Hiroaki Kawanishi, and Yuka Kono from Tenriyorozu Hospital; Mutsushi Kawakita and Masashi Kubota from Kobe City Medical Center General Hospital; Noriyuki Ito and Yosuke Shimizu from Nishikobe Medical Center; Toshiyuki Kamoto and Masato Fujii from Miyazaki University; Tomomi Kamba and Kenichiro Tanoue from Kumamoto University; Yasumasa Shichiri and Akihiro Hamada from Otsu Municipal Hospital; Toshiya Akao and Noboru Shibasaki from Rakuwakai Otowa Hospital; Seiji Moroi and Go Kobori from Hamamatsu Rosai Hospital.
Compliance with ethical standards
Conflict of interest
No author has any conflict of interest.
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