Comparative Perioperative Outcomes in Septuagenarians and Octogenarians Undergoing Radical Cystectomy: Beyond the Abstract

Radical cystectomy (RC) is the standard of care for muscle invasive bladder cancer (MIBC) for patients deemed suitable candidates for surgical intervention.  Despite these recommendations multiple studies have shown that octogenarians are less likely to receive radical cystectomy compared to their younger peers.  Octogenarians have been shown to have an odds ratio of 0.1 of receiving a radical cystectomy compared to peers aged 66-69. 

We based our study on our belief that urologists are less likely to offer RC to octogenarians due to perceived increased risk of morbidity and mortality in this age group. The goal of our study was to compare octogenarians and septuagenarians to determine risk of morbidity and mortality. 

Overall, no significant difference was noted in the rates of serious complications between the two groups when comparing cardiac, respiratory and wound complications. There was a slightly higher risk of mortality associated with the octogenarians group compared to septuagenarians (4.3% vs. 2.3%; p= .04).  

Chronological age alone should not be used as the sole indicator determining surgical intervention of radical cystectomy for patients with MIBC.  Many other factors play a role in determining surgical candidacy.  Expectation management is important for providers and patients and it requires a lengthy thorough discussion about radical cystectomy and urinary diversion.  Octogenarians should be educated and risk assessed for radical cystectomy similar to younger patients.  

Written by: Tyler Haden, MD, Division of Urology, University of Missouri School of Medicine, Columbia, Missouri and Naveen Pokala, MD, Director of Robotic Urology, Division of Urology, Ellis Fishel Cancer Center, University of Missouri

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