Radical cystectomy in patients aged ≥75 years : an updated review of patients treated with curative and palliative intent

To evaluate the morbidity and mortality of radical cystectomy in a group of unselected patients older than 75 years who were treated with curative and palliative intent. We retrospectively analysed 53 patients aged 75- 90 years (median 78.8 years)who had radical cystectomies between May 1994 and July 2002. The patients were divided into two groups: 46 were treated with curative intent (group A)and seven with palliative intent (group B). The indications for cystectomy in group A were recurrent and otherwise therapy-resistant bladder cancer, severe irritative voiding symptoms and recurrent macrohaematuria. The indications in group B were advanced pelvic malignancy with severe irritative voiding symptoms, severe pain, and recurrent macrohaematuria requiring blood transfusions. Patients were categorized according to the American Society of Anaesthesiologists (ASA) classification with a score of II in 28, III in 21 and IV in four patients. Complications and mortality before, during and after surgery, and the duration of hospital stay and clinical outcome, were assessed. The early mortality rate in group A was 4% (2/46) ; in group B two patients died after prolonged complications. The median (range)hospital stay was 28(6-56)days, and was significantly longer in patients with complications, at a median (range)of 36(6-70)days. The complication rates early and late after surgery in group A were 22% and 11%, respectively, and in group B, five of seven (early).The total median survival was 2 (0.33-7)years. Elderly people undergoing radical cystectomy have a greater risk of perioperative morbidity and mortality, especially those with very advanced pelvic malignancies who have had cystectomy with palliative intent.The incidence of early and late complications in patients treated with curative intent is acceptable, but the hospital stay is prolonged.