Older patients suffer from adverse histopathological features after radical cystectomy
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Older patients suffer from adverse histopathological features after radical cystectomy. / Rink, Michael; Dahlem, Roland; Kluth, Luis; Minner, Sarah; Ahyai, Sascha A; Eichelberg, Christian; Fisch, Margit; Chun, Felix Kh.
In: INT J UROL, Vol. 18, No. 8, 08.2011, p. 576-84.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Older patients suffer from adverse histopathological features after radical cystectomy
AU - Rink, Michael
AU - Dahlem, Roland
AU - Kluth, Luis
AU - Minner, Sarah
AU - Ahyai, Sascha A
AU - Eichelberg, Christian
AU - Fisch, Margit
AU - Chun, Felix Kh
N1 - © 2011 The Japanese Urological Association.
PY - 2011/8
Y1 - 2011/8
N2 - OBJECTIVES: Radical cystectomy (RC) remains a complex procedure in older patients. Perioperative morbidity can be significant and it can represent a limitation for its indication in this population. The aim of the present study was to evaluate the outcomes of RC in elderly patients from a large single-center cohort.METHODS: A total of 447 patients who underwent RC between 1996 and 2009 at our institution were considered. Patients were stratified by age (≤70 vs >70 years). Logistic regression analyses were carried out comparing both groups regarding clinical, perioperative and histopathological findings, as well as complications according to the modified Clavien system and survival.RESULTS: Data of 390 patients were available for the analysis. Of these, 265 (67.9%) versus 125 (32.1%) patients were <70 versus ≥70 years-of-age. The median age was 61 and 75 years, respectively. In the elderly, ASA score (P < 0.001), delay between transurethral resection of the bladder (TURBT) and RC (P = 0.004), and number of perioperative blood transfusions (P = 0.002) were significantly higher. Additionally, a clear trend towards higher stages (pT3-4) was observed (P = 0.04). However, complications, and overall and cancer-specific mortality were not increased in older patients. Finally, age was identified as a significant risk factor for upstaging (P = 0.04). Upstaging between TURBT and final histopathology in patients <70 versus ≥70 years occurred in 45% versus 58%, respectively (P = 0.03).CONCLUSIONS: RC is equally feasible in older patients without increasing morbidity or mortality. On the contrary, older patients have a higher risk of significant upstaging and advanced stages at final histopathology. These findings suggest that RC should neither be delayed in nor withheld from elderly patients.
AB - OBJECTIVES: Radical cystectomy (RC) remains a complex procedure in older patients. Perioperative morbidity can be significant and it can represent a limitation for its indication in this population. The aim of the present study was to evaluate the outcomes of RC in elderly patients from a large single-center cohort.METHODS: A total of 447 patients who underwent RC between 1996 and 2009 at our institution were considered. Patients were stratified by age (≤70 vs >70 years). Logistic regression analyses were carried out comparing both groups regarding clinical, perioperative and histopathological findings, as well as complications according to the modified Clavien system and survival.RESULTS: Data of 390 patients were available for the analysis. Of these, 265 (67.9%) versus 125 (32.1%) patients were <70 versus ≥70 years-of-age. The median age was 61 and 75 years, respectively. In the elderly, ASA score (P < 0.001), delay between transurethral resection of the bladder (TURBT) and RC (P = 0.004), and number of perioperative blood transfusions (P = 0.002) were significantly higher. Additionally, a clear trend towards higher stages (pT3-4) was observed (P = 0.04). However, complications, and overall and cancer-specific mortality were not increased in older patients. Finally, age was identified as a significant risk factor for upstaging (P = 0.04). Upstaging between TURBT and final histopathology in patients <70 versus ≥70 years occurred in 45% versus 58%, respectively (P = 0.03).CONCLUSIONS: RC is equally feasible in older patients without increasing morbidity or mortality. On the contrary, older patients have a higher risk of significant upstaging and advanced stages at final histopathology. These findings suggest that RC should neither be delayed in nor withheld from elderly patients.
KW - Age Factors
KW - Aged
KW - Cystectomy
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Postoperative Complications
KW - Prospective Studies
KW - Survival Rate
KW - Urinary Bladder Neoplasms
KW - Journal Article
U2 - 10.1111/j.1442-2042.2011.02794.x
DO - 10.1111/j.1442-2042.2011.02794.x
M3 - SCORING: Journal article
C2 - 21699582
VL - 18
SP - 576
EP - 584
JO - INT J UROL
JF - INT J UROL
SN - 0919-8172
IS - 8
ER -