We compared the perioperative and oncological outcomes of laparoscopic radical cystectomy (LRC) between elderly patients over 75 years old and younger patients.
MATERIALS AND METHODS:
The aim of this study was to compare the morbidity, mortality, oncological results and quality of life between laparoscopic radical cystectomy (LRC) with ileal conduit in 20 elderly (≥75 years.) versus 31 younger (< 75 years.) patients. Between January 2015 and Jule 2016, 51 patients were recruited into this study. Baseline patient characteristics, pathological factors, operative and postoperative characteristics, postoperative complications and survival data were retrospectively collected, analyzed and compared between the two groups.
Median age difference between LRC groups was 15.2 years (77.5 versus 62.3 years). Both groups had similar surgical indications, body mass index and gender distribution. Charlson Comorbidity Index score was 3 versus 4 in ≥50% of younger and elderly patients. Median operative time (269 versus 276 min) and estimated blood loss (378 versus 368 mL) did not differ between groups. Median total hospital stay was 13.0 versus 15.0 days for younger and elderly patients.
Perioperative pyelonephritis was significantly more frequent in the elderly group (50% vs 20%, p＝0.02), while other complications were not significantly different between the two groups. The perioperative mortality rate was 0% in both groups. Grade I-II 90-d complication rate was higher for elderly patients (65 versus 39%, p=0.05). Grade III-V 90-d complication rate was equal for both groups (25 versus 29%, p=0.557). 90-d mortality rate was higher for elderly patients (10 versus 3%, p=0.157).
There were no significant differences between the elderly and young groups with respect to 2-year overall survival (72. 7% vs 88. 4%), cancer-specific survival (70. 6% vs 89. 3%), and recurrence-free survival (67.3% vs 79. 9%). LRC is a safe andefficient procedure for selected elderly patients.
Our results suggest that LRC is feasible in elderly patients with muscle invasive bladder cancer or non-muscle invasive bladder cancer with high risk factors, where a nonsurgical treatment is usually favoured.