RADICAL CYSTECTOMY IN THE OCTOGENARIAN

Purpose: We evaluated the morbidity and outcome of cystectomy and urin ary diversion in patients 80 years old or older with invasive bladder cancer. Materials and Methods: We reviewed the records of all patients older than 80 years who underwent cystectomy during the last 15 years . Of 1,186 cystectomies 44 patients (4%) were identified. Patients wer e evaluated for complications, mortality and functional status after s urgery. Results: The 44 patients had a median age of 81 years (range 8 0 to 87). Of the patients 78% had significant co-morbidity, including 41% with 2 or more medical problems. Median hospital stay was 14 days, with 20% of the patients requiring intensive care for 24 hours. There was a 51% complication rate including 25% due to surgical complicatio ns and 26% from underlying medical illness. Operative mortality was 4. 5%. Within 6 months of surgery 66% were rehospitalized for medical or surgical reasons. Median survival time was 25 months. Median performan ce status before and after surgery decreased slightly from 70 to 65. C onclusions: The results of this study support the use of cystectomy in octogenarians with invasive bladder cancer. Surgery can be accomplish ed with acceptable morbidity and mortality. Radical cystectomy in this population offers the best opportunity for sustained disease-free qua lity survival.