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Morbidity, mortality, and quality assessment following open radical cystectomy in elderly patients with bladder cancer

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Abstract

Background

Open radical cystectomy (ORC) with pelvic lymph-node dissection (PLND) for bladder cancer (BCa) and urinary diversion is a morbid procedure, and advanced age has been associated with a higher incidence of Clavien–Dindo ≥ 3 complications.

Aim

To investigate the association between chronological age, survival outcomes, incidence of perioperative complications, and quality parameters in patients undergoing ORC.

Methods

We reviewed 413 patients who underwent ORC and PLND at a single academic centre between December 2009 and June 2018 for cT2-T4N0M0 BCa. Complete clinical, demographic, and pathological data were collected in the preoperative, preoperative, and postoperative setting. Patients were categorized as ≥ 75 years or < 75 years and statistical analysis was performed accordingly. Besides descriptive statistics, Kaplan–Meier log-rank test was used. Cox regression univariate and multivariate analyses were used to assess any potential predictor of OS and CSS.

Results

There were 285 (69%) patients < 75 years and 128 (31%) patients ≥ 75 years old. There was no significant difference between the two age groups neither in terms of distribution of pathological stage nor in terms of overall incidence of postoperative complications. Chronological age was not significantly associated with survival outcomes on multivariate analysis. Finally, the comorbidity index was the only significant risk factor for the incidence of any complications (OR = 0.83, p = 0.002) at multivariate binary logistic regression.

Conclusion

Open radical cystectomy (ORC) is a feasible and safe procedure in patients with high-risk non-metastatic bladder cancer. Uro-oncologists should consider evaluating elderly patients for surgery according to a thorough geriatric assessment despite chronological age.

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Authors and Affiliations

  1. Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy

    Tommaso Prayer Galetti, Matteo Soligo, Alessandro Morlacco, Valeria Lami, Alex Anh Ly Nguyen, Massimo Iafrate & Filiberto Zattoni

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  1. Tommaso Prayer Galetti
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  2. Matteo Soligo
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  3. Alessandro Morlacco
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Correspondence to Tommaso Prayer Galetti.

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Prayer Galetti, T., Soligo, M., Morlacco, A. et al. Morbidity, mortality, and quality assessment following open radical cystectomy in elderly patients with bladder cancer. Aging Clin Exp Res 33, 1049–1061 (2021). https://doi.org/10.1007/s40520-020-01613-0

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