Radical cystectomy is safe in elderly patients at high risk

Purpose: Radical cystectomy is standard treatment for bladder cancer in hea lthy individuals. We determined the safety of radical cystectomy in elderly patients at high risk. Materials and Methods: We reviewed the records of all patients who underwen t radical cystectomy at our institution between January 1994 and June 2000. Of these 382 patients we identified 44 who were elderly and at high risk, as defined by age 75 years or greater and American Society of Anesthesiolog ists classification 3 or greater. We examined postoperative care, periopera tive minor/major complications, the mortality rate and the need for rehospi talization. Results: Median age of the 44 patients was 77.5 years (range 75 to 87). Ame rican Society of Anesthesiologists class was 3 in 40 patients and 4 in 4. M edian hospitalization was 7 days (range 4 to 20). Postoperatively 31 of the 44 patients (70%) were transferred directly to the general urology floor, while cardiac monitoring was required postoperatively in 30%. Nine of these patients were transferred to a step-down unit and the remaining 4 required surgical intensive care unit admission. Minor and major complications deve loped in 10 (22.7%) and 2 (4.5%) cases, respectively. No patients died in t he perioperative period and 4 patients were hospitalized within 6 months of discharge home. Conclusions: Our results support the safety of radical cystectomy in elderl y patients at high risk. Acceptable perioperative morbidity and mortality m ay be achieved without routine intensive monitoring postoperatively.