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The role of cystectomy in elderly patients - a multicentre analysis.

Identifieur interne : 002831 ( PubMed/Curation ); précédent : 002830; suivant : 002832

The role of cystectomy in elderly patients - a multicentre analysis.

Auteurs : Laura Izquierdo [Espagne] ; Lluis Peri [Espagne] ; Priscila Leon [France] ; Miguel Ramírez-Backhaus [Espagne] ; Thomas Manning [Australie] ; Antonio Alcaraz [Espagne] ; Morgan Roupret [France] ; Eduardo Solsona [Espagne] ; Jose Rubio [Espagne] ; Shomik Sengupta [Australie] ; Yee Chan [Australie] ; Peter Liodakis [Australie] ; Dennis Gyomber [Australie] ; Damien Bolton [Australie] ; Nathan Lawrentschuk [Australie]

Source :

RBID : pubmed:26333289

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English descriptors

Abstract

Life expectancy in developed countries is continuously increasing. Hence elderly patients are becoming more common in our clinical practice. Currently, one of the greatest challenges of medicine is balancing the life expectancy of elderly patients against aggressive treatments that carry significant risks.

DOI: 10.1111/bju.13227
PubMed: 26333289

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pubmed:26333289

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<nlm:affiliation>Department of Urology, Hospital Clinic, Barcelona, Spain.</nlm:affiliation>
<country xml:lang="fr">Espagne</country>
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<name sortKey="Peri, Lluis" sort="Peri, Lluis" uniqKey="Peri L" first="Lluis" last="Peri">Lluis Peri</name>
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<nlm:affiliation>Department of Urology, La Pitié-Salpetrière Hospital, Paris, France.</nlm:affiliation>
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<name sortKey="Ramirez Backhaus, Miguel" sort="Ramirez Backhaus, Miguel" uniqKey="Ramirez Backhaus M" first="Miguel" last="Ramírez-Backhaus">Miguel Ramírez-Backhaus</name>
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<name sortKey="Solsona, Eduardo" sort="Solsona, Eduardo" uniqKey="Solsona E" first="Eduardo" last="Solsona">Eduardo Solsona</name>
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<name sortKey="Rubio, Jose" sort="Rubio, Jose" uniqKey="Rubio J" first="Jose" last="Rubio">Jose Rubio</name>
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<name sortKey="Sengupta, Shomik" sort="Sengupta, Shomik" uniqKey="Sengupta S" first="Shomik" last="Sengupta">Shomik Sengupta</name>
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<nlm:affiliation>Department of Surgery, University of Melbourne, Heidelberg, Vic., Australia.</nlm:affiliation>
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<name sortKey="Chan, Yee" sort="Chan, Yee" uniqKey="Chan Y" first="Yee" last="Chan">Yee Chan</name>
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<name sortKey="Gyomber, Dennis" sort="Gyomber, Dennis" uniqKey="Gyomber D" first="Dennis" last="Gyomber">Dennis Gyomber</name>
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<name sortKey="Bolton, Damien" sort="Bolton, Damien" uniqKey="Bolton D" first="Damien" last="Bolton">Damien Bolton</name>
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<wicri:regionArea>Department of Surgery, University of Melbourne, Heidelberg, Vic.</wicri:regionArea>
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<name sortKey="Lawrentschuk, Nathan" sort="Lawrentschuk, Nathan" uniqKey="Lawrentschuk N" first="Nathan" last="Lawrentschuk">Nathan Lawrentschuk</name>
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<nlm:affiliation>Department of Surgery, University of Melbourne, Heidelberg, Vic., Australia.</nlm:affiliation>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Department of Surgery, University of Melbourne, Heidelberg, Vic.</wicri:regionArea>
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<name sortKey="Roupret, Morgan" sort="Roupret, Morgan" uniqKey="Roupret M" first="Morgan" last="Roupret">Morgan Roupret</name>
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<nlm:affiliation>Department of Urology, Fundación IVO, Valencia, Spain.</nlm:affiliation>
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<name sortKey="Rubio, Jose" sort="Rubio, Jose" uniqKey="Rubio J" first="Jose" last="Rubio">Jose Rubio</name>
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<name sortKey="Bolton, Damien" sort="Bolton, Damien" uniqKey="Bolton D" first="Damien" last="Bolton">Damien Bolton</name>
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<nlm:affiliation>Department of Surgery, University of Melbourne, Heidelberg, Vic., Australia.</nlm:affiliation>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Department of Surgery, University of Melbourne, Heidelberg, Vic.</wicri:regionArea>
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<name sortKey="Lawrentschuk, Nathan" sort="Lawrentschuk, Nathan" uniqKey="Lawrentschuk N" first="Nathan" last="Lawrentschuk">Nathan Lawrentschuk</name>
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<nlm:affiliation>Department of Surgery, University of Melbourne, Heidelberg, Vic., Australia.</nlm:affiliation>
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<wicri:regionArea>Department of Surgery, University of Melbourne, Heidelberg, Vic.</wicri:regionArea>
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<title level="j">BJU international</title>
<idno type="eISSN">1464-410X</idno>
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<keywords scheme="KwdEn" xml:lang="en">
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Cystectomy</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Length of Stay</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Operative Time</term>
<term>Postoperative Complications</term>
<term>Prospective Studies</term>
<term>Quality of Life (psychology)</term>
<term>Survival Rate</term>
<term>Treatment Outcome</term>
<term>Urinary Bladder Neoplasms (mortality)</term>
<term>Urinary Bladder Neoplasms (psychology)</term>
<term>Urinary Bladder Neoplasms (surgery)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr">
<term>Adulte d'âge moyen</term>
<term>Complications postopératoires</term>
<term>Cystectomie</term>
<term>Durée du séjour</term>
<term>Durée opératoire</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
<term>Qualité de vie (psychologie)</term>
<term>Résultat thérapeutique</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Taux de survie</term>
<term>Tumeurs de la vessie urinaire ()</term>
<term>Tumeurs de la vessie urinaire (mortalité)</term>
<term>Tumeurs de la vessie urinaire (psychologie)</term>
<term>Études de suivi</term>
<term>Études prospectives</term>
</keywords>
<keywords scheme="MESH" qualifier="mortality" xml:lang="en">
<term>Urinary Bladder Neoplasms</term>
</keywords>
<keywords scheme="MESH" qualifier="mortalité" xml:lang="fr">
<term>Tumeurs de la vessie urinaire</term>
</keywords>
<keywords scheme="MESH" qualifier="psychologie" xml:lang="fr">
<term>Qualité de vie</term>
<term>Tumeurs de la vessie urinaire</term>
</keywords>
<keywords scheme="MESH" qualifier="psychology" xml:lang="en">
<term>Quality of Life</term>
<term>Urinary Bladder Neoplasms</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en">
<term>Urinary Bladder Neoplasms</term>
</keywords>
<keywords scheme="MESH" xml:lang="en">
<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Cystectomy</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Length of Stay</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Operative Time</term>
<term>Postoperative Complications</term>
<term>Prospective Studies</term>
<term>Survival Rate</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr">
<term>Adulte d'âge moyen</term>
<term>Complications postopératoires</term>
<term>Cystectomie</term>
<term>Durée du séjour</term>
<term>Durée opératoire</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
<term>Résultat thérapeutique</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
<term>Taux de survie</term>
<term>Tumeurs de la vessie urinaire</term>
<term>Études de suivi</term>
<term>Études prospectives</term>
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<front>
<div type="abstract" xml:lang="en">Life expectancy in developed countries is continuously increasing. Hence elderly patients are becoming more common in our clinical practice. Currently, one of the greatest challenges of medicine is balancing the life expectancy of elderly patients against aggressive treatments that carry significant risks.</div>
</front>
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<PMID Version="1">26333289</PMID>
<DateCreated>
<Year>2015</Year>
<Month>10</Month>
<Day>27</Day>
</DateCreated>
<DateCompleted>
<Year>2016</Year>
<Month>02</Month>
<Day>25</Day>
</DateCompleted>
<DateRevised>
<Year>2016</Year>
<Month>04</Month>
<Day>20</Day>
</DateRevised>
<Article PubModel="Print-Electronic">
<Journal>
<ISSN IssnType="Electronic">1464-410X</ISSN>
<JournalIssue CitedMedium="Internet">
<Volume>116 Suppl 3</Volume>
<PubDate>
<Year>2015</Year>
<Month>Oct</Month>
</PubDate>
</JournalIssue>
<Title>BJU international</Title>
<ISOAbbreviation>BJU Int.</ISOAbbreviation>
</Journal>
<ArticleTitle>The role of cystectomy in elderly patients - a multicentre analysis.</ArticleTitle>
<Pagination>
<MedlinePgn>73-9</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1111/bju.13227</ELocationID>
<Abstract>
<AbstractText Label="INTRODUCTION" NlmCategory="BACKGROUND">Life expectancy in developed countries is continuously increasing. Hence elderly patients are becoming more common in our clinical practice. Currently, one of the greatest challenges of medicine is balancing the life expectancy of elderly patients against aggressive treatments that carry significant risks.</AbstractText>
<AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">To outline the complications and survival in surgical patients 80 years and over undergoing radical cystectomy for bladder cancer.</AbstractText>
<AbstractText Label="PATIENTS AND METHODS" NlmCategory="METHODS">A review of a radical cystectomy in elderly recorded in four different institutional prospective databases during the period between 1991 and 2014. Clinical and pathologic features, complications and survival were evaluated.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">A total of 111 patients were available. Median (range) age 82.2 (80-89) years. Seventeen women and 94 men. Regarding the ASA score, 6 patients were ASA I, 47 patients were ASA II, 49 patients ASA III and 9 ASA IV. Prior to surgery, 48 patients had hydronephrosis. The median (range) creatinine series was 1.1 (0.71-11.1) ng/dL. In 88 cases an ileal conduit was performed, 17 a cutaneous ureterostomy diversion, 5 neobladders and 1 ureterosigmoidostomy case. The median (range) operative time was 230 (120-420) min and a total of 97 patients required blood transfusion. The median (range) hospital stay was 14 (7-126) days. The early and late complication rates were 50.4% and 32%, respectively. A total of 14 patients (12.6%) required surgical reintervention. Eight patients (7.2%) died in the immediate postoperative period. The readmission rate of the series was 27.2%. The mean follow-up of the series was 18 (0.27-134.73) months. During this period 66 patients died, 52 of them due to the tumor. Twelve month tumour progression free survival was 83.9% for ≤pT1, 70.2% for pT2 and 36% for ≥pT3, respectively. Twelve month cancer specific survival was 85.6% for ≤pT1, 75.1% for pT2 and 42.5% for ≥pT3, respectively.</AbstractText>
<AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">Radical cystectomy in elderly population is an aggressive surgical treatment with a significant complication rate, hospital readmission and perioperative mortality rate. Careful selection of patients is essential in order to minimize the complications of this surgery and balance benefits against risks in the elderly population. Tumour progression and cancer specific survival are poor for patients with ≥pT3 disease. Alternatives such as tri-modality therapy need to be considered within a multi-disciplinary approach. More data is required to determine which sub-groups of elderly patients would benefit from a complication, survival and quality of life perspective.</AbstractText>
<CopyrightInformation>© 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.</CopyrightInformation>
</Abstract>
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<Author ValidYN="Y">
<LastName>Izquierdo</LastName>
<ForeName>Laura</ForeName>
<Initials>L</Initials>
<AffiliationInfo>
<Affiliation>Department of Urology, Hospital Clinic, Barcelona, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Peri</LastName>
<ForeName>Lluis</ForeName>
<Initials>L</Initials>
<AffiliationInfo>
<Affiliation>Department of Urology, Hospital Clinic, Barcelona, Spain.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Leon</LastName>
<ForeName>Priscila</ForeName>
<Initials>P</Initials>
<AffiliationInfo>
<Affiliation>Department of Urology, La Pitié-Salpetrière Hospital, Paris, France.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Ramírez-Backhaus</LastName>
<ForeName>Miguel</ForeName>
<Initials>M</Initials>
<AffiliationInfo>
<Affiliation>Department of Urology, Fundación IVO, Valencia, Spain.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Manning</LastName>
<ForeName>Thomas</ForeName>
<Initials>T</Initials>
<AffiliationInfo>
<Affiliation>Department of Surgery, University of Melbourne, Heidelberg, Vic., Australia.</Affiliation>
</AffiliationInfo>
</Author>
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<Keyword MajorTopicYN="N">complications</Keyword>
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<Keyword MajorTopicYN="N">radical cystectomy</Keyword>
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