Radical cystectomy in the elderly patient: a contemporary comparison of perioperative complications in a single institution series

To report on our recent experience with peri- and postoperative morbidity of radical cystectomy in patients 75 years and older compared to younger patients. Medical records of 326 consecutive patients undergoing radical cystectomy from May 2004 through April 2008 were reviewed. Eighty-five of 326 patients (26%) were a parts per thousand yen75 years (75-95) old. ASA score was equal 3 or greater in 51% of patients a parts per thousand yen75 years and 32% of patients < 75 years. Ileal conduit was performed in 83% of patients a parts per thousand yen75, 16% received an ileal neobladder compared to 46 and 51%, respectively, in patients < 75. A total of 33 patients (39%) in the older patient group received blood transfusions intraoperatively compared to 76 patients (32%) in the younger age group. In 6 patients a parts per thousand yen75 years (7.1%) and 17 patients < 75 (7.1%) open surgical revision was necessary, perioperative complication rate was 22 and 21%, respectively. The most common complications were wound dehiscence (5.9 vs. 7.5%), infections (4.7 vs. 4.6%), and pulmonary embolism (3.5 vs. 2.1%). Perioperative mortality was 1.2% (1 patient) in the elderly versus 0.4% (1 patient) in the younger age group. Our data show that radical cystectomy can be offered to the elderly patient with acceptable morbidity. Because of higher comorbidity rate in the elderly, therapeutic decision for radical cystectomy in elderly patients should be made carefully and individually. Nevertheless our results demonstrate that age itself is not a main criterion which has to be considered strongly in decision making for radical cystectomy.