Vol. 42 (6): 1099-1108, November – December, 2016
Laparoscopic Radical Cystectomy in the Elderly – Results of a Single Center LRC only Series
Tom J. N. Hermans 1, Laurent M. C. L. Fossion 1, Rob Verhoeven 2, Simon Horenblas 3
1 Department of Urology, Maxima Medical Center Veldhoven, Veldhoven, The Netherlands; 2 Eindhoven Cancer Registry/Comprehensive Cancer Centre South, Eindhoven, Netherlands; 3 Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
Objective: To compare outcome of laparoscopic radical cystectomy (LRC) with ileal conduit in 22 elderly (≥75 years.) versus 51 younger (<75 years.) patients.
Materials and Methods: Analysis of prospectively gathered data of a single institution LRC only series was performed. Selection bias for LRC versus non-surgical treatments was assessed with data retrieved from the Netherlands Cancer Registry.
Results: Median age difference between LRC groups was 9.0 years. (77.0 versus 68.0 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 (340 versus 341 min) and estimated blood loss (<500 versus >500mL) did not differ between groups. Median total hospital stay was 12.0 versus 14.0 days for younger and elderly patients. Grade I-II 90-d complication rate was higher for elderly patients (68 versus 43%, p=0.05). Grade III-V 90-d complication rate was equal for both groups (23 versus 29%, p=0.557). 90-d mortality rate was higher for elderly patients (14 versus 4%, p=0.157). Median follow-up was 40.0 months for younger and 57.0 months for elderly patients. Estimated overall and cancer-specific survival at 5years. was 46% versus 35% and 64% versus 64% for younger and elderly patients respectively.
Conclusions: Our results suggest that LRC is feasible in elderly patients, where a non-surgical treatment is usually favoured.
Keywords: Cystectomy; Geriatrics; Minimally Invasive Surgical Procedures; Survival; Urinary Bladder Neoplasms