Long-Term Results of Radical Cystectomy in Elderly Patients with Comorbidity

ABSTRACT

PURPOSE: Radical cystectomy is a standard treatment for muscle-invasive bladder cancer in healthy individuals. However, few data are available on radical cystectomy in elderly patients with comorbidity. We determined the safety of radical cystectomy and the long-term benefit and survival outcomes after radical cystectomy in elderly patients with comorbidity. MATERIALS AND METHODS: We reviewed the records of all patients undergoing radical cystectomy between 1986 and 2005. We identified 31 elderly patients with comorbidity, as defined by age 75 years or greater and American Society of Anesthesiologist (ASA) classification 3. We analyzed patient characteristics, presenting symptoms, surgical outcomes including perioperative complications, pathologic stage, and survival. RESULTS: The patients' median age was 77 years (range, 75-89 years). ASA class was 3 in 31 patients. Complications developed in 8 cases (25.8%). Postoperatively, 6 of the 31 patients (20%) were transferred directly to the general urology floor. No patients died in the perioperative period or were hospitalized within 6 months of discharge home. During the follow-up period of 54 months (range, 11-135 months), 11 (31.4%) patients were alive. Cause of death was known in 20 patients, with majority (7/20) because of bladder cancer. Kaplan-Meier survival curves demonstrated that patients with organ-confined disease had a significantly longer overall survival than did patients with non-organ-confined disease. CONCLUSIONS: Our results support the safety and feasibility of radical cystectomy in elderly patients with comorbidity. Palliation of local symptoms, local cancer control, and long-term survival benefit might be expected after radical cystectomy, especially in patients with organ-confined disease.