Radical cystectomy for carcinoma of urinary bladder is safe in selected elderly population over the age of 75: A multicentre cohort analysis of 16-year experience in Hong Kong

Abstract

Objective:

The aim of this study was to determine clinical factors that were associated with mortality following radical cystectomy.

Patients and Methods:

Patients with carcinoma of urinary bladder and radical cystectomy performed between 1st January 2000 to 31st December 2016 in Queen Mary Hospital and Kwong Wah Hospital were retrospectively reviewed. Patient demographics, comorbidities, pre‐operative investigations and pathology were analysed.

Results:

One hundred and sixty‐two patients with median age of 70.0 ± 10.0 were included. The mean follow‐up duration was 55.4 ± 51.2 months. The 5‐year overall survival and cancer‐specific survival rate were 63.0% and 73.5% respectively. The 30‐day mortality and complication rate were 4.3% and 32.1% respectively.

Only albumin ≤35 g/L, ASA score ≥3 and tumour stage T ≥ 3 and N ≥ 1 were independent predictors for overall mortality after radical cystectomy upon multivariate analysis (p = 0.039, p = 0.009, p = 0.046 and p = 0.000 respectively). Age ≥75, perioperative transfusion, high Charlson‐comorbidity index and Neutrophil‐to‐Lymphocyte ratio were not associated with increased mortality or morbidity.

Conclusion:

Pre‐operative albumin <35 g/L and ASA score ≥3 were useful indicators for mortality following radical cystectomy. Evaluation of patient's performance status and comorbidities were more important than chronological age in patients with carcinoma of bladder.