@article{3153260,
    title = "Radical cystectomy over the age of 75 is safe and increases survival",
    author = "Tyritzis, Stavros I. and Anastasiou, Ioannis and Stravodimos, and Konstantinos G. and Alevizopoulos, Aristeides and Kollias, Anastasios and and Balangas, Antonios and Katafigiotis, Ioannis and Leotsakos, Ioannis and and Mitropoulos, Dionysios and Constantinides, Constantinos A.",
    journal = "BMC Geriatrics",
    year = "2012",
    volume = "12",
    publisher = "BioMed Central Ltd.",
    issn = "1471-2318",
    doi = "10.1186/1471-2318-12-18",
    keywords = "Radical cystectomy; Octogenarians; Complications; Survival; Clavien
classification system; Charlson comorbidity index",
    abstract = "Background: Radical cystectomy (RC) is probably underused in elderly
patients due to a potential increased postoperative complication risk,
as reflected by their considerable comorbidities. Our objective was to
estimate the overall complication rate and investigate a potential
benefit to patients over the age of 75 subjected to RC in terms of
disease-free survival.
Methods: A total of 81 patients, 61 men and 20 women, from two
urological departments, with a mean age of 79.2 +/- 3.7 years,
participated in the study. The mean follow-up period was 2.6 +/- 1.6
years. All patients underwent RC with pelvic lymphadenectomy. An ileal
conduit, an orthotopic ileal neobladder and cutaneous ureterostomies
were formed in 48.1%, 6.2% and 45.7% of the patients, respectively.
The perioperative and 90-day postoperative complications were recorded
and classified according to the modified Clavien classification system.
Survival plots were created based on the oncological outcome and several
study parameters.
Results: The perioperative morbidity rate was 43.2%; the 90-day
morbidity rate was 37%, while the 30-day, 90-day and overall mortality
rates were 3.7%, 3.7% and 21%, respectively. Overall mortality rates
were recorded at the final year of data gathering (2009). Increased age,
increased body mass index (BMI), longer hospitalization and age-adjusted
Charlson comorbidity index (ACCI) more than six, were associated with
greater hazard for 90-day morbidity. The cumulative mortality
/metastasis-free rates for one, two, three and five years were 88.7%,
77.5%, 70.4%, and 62.3%, respectively. Tumour stage and positive
nodes were prognostic predictors for oncological outcome.
Conclusions: RC in patients over 75 is justified and feasible, due to
acceptable complication rates and high 5-year cancer-specific survival,
which support an aggressive approach. Prospective studies are needed for
the verification of the above results."
}