Introduction

Following the global trend of population aging, researchers and clinicians are increasingly facing the challenges of surgical management of malignancies in elderly patients. Although RC is a long-established treatment of muscle-invasive bladder cancer, little data are available on the postoperative outcomes of this intervention in the octogenarians. Contemporary representative open RC series report an overall complication rate ranging between 30% and 70% for any age category. Complication rate for our octogenarians lie within this range. The aim of our study was to evaluate the safety of open radical cystectomy (RC) in octogenarians, considering the potentially higher risk for postoperative complications due to the generally unfavourable comorbidity profile in this patient category.

Methods

We retrospectively evaluated a cohort of 44 patients aged ≥80 years treated with open RC and urinary diversion at two high-volume urology units between July 2013 and December 2015. Median age was 83 years. Charlson score was ≥3 in 41 (93%) patients, and ASA score was ≥ 3 in 34 (77%) patients. RC was performed in 42 (95%) patients for muscle-invasive bladder cancer and in 2 (5%) patients for benign disease._x000D_ Orthotopic ileal neobladder (V.I.P. technique), ileal conduit and cutaneous ureterostomies were performed in 1 (2%), 20(45%) and 20 (45%) patients, respectively. In 3 (8%) patients no urinary diversion was performed since they were already on dialysis for chronic kidney disease. Primary outcome was rate of 90-day complications graded according to Dindo-Clavien classification. Secondary outcomes were: operative time,estimated blood loss, recovery of bowel activity measured as timing of stool passage, and length of hospital stay.

Results

Overall 90-day complications were recorded in 23(52%) pts. Complications were grade II in 11 (25%) patients (blood transfusions), grade IIIa in 5 (11%) (1 wound dehiscence,1uretero-ileal leakage, 1 uretero-ileal stricture, 1 urinary fistula and 1 unilateral hydroureteronephrosis treat with nephrostomy), grade IIIb in 5 (11%) (3 wound dehiscence, 1 bowel obstruction, 1 pelvic bleeding), grade IV in 1 (2%) (myocardial infarction) and grade V in 1 (2%).Median operative time was 258 min (interquartile range [IQR]190-305). Median estimated blood losswas 700 ml (IQR 550-840). Stool passage was observed in 2 (5%) patients on POD 1, in 2 (5%) on POD 2, in 4 (9%) on POD 3, in 6 (14%) on POD 4 and in 30 (68%) on POD ≥5. Median length of hospital stay was 13 days (IQR 8-17).

Conclusions

Open RC in octogenarians appears feasible with an acceptable complication rate. Thus, ages hould not be considered as an absolute exclusion criterion for RC, particularly when this operationis performed in high-volume referral centres.

Funding

None