Younger patients with stage II-III invasive bladder cancer can often effectively be treated with radical cystectomy (complete surgical removal of the bladder) and urinary diversion. There is, however, a reluctance to subject older patients to radical cystectomy for fear of a higher rate of complications.
In order to evaluate the risk of undergoing cystectomy in older patients with invasive bladder cancer, physicians at the Kenneth Norris, Jr. Comprehensive Cancer Center in Los Angeles reviewed the results achieved with radical cystectomy and urinary diversion in 404 patients 70 years of age or older.
The risk of dying as a complication from surgery for patients age 70 or over was 2.8%, which compared to a 2% risk observed for younger patients. Early complications from surgery occurred in 32% of patients age 70 years or older compared to 25% of younger patients. Late operative complications occurred in 12.4% of patients age 70 years or older compared to 23% of younger patients. Thirty-five percent of patients age 70 years and older experienced recurrent cancer within 5 years of treatment compared to 31% for younger patients. The 5-year survival was 53% for patients age 70 years or older compared to 63% for younger patients.
Treatment with cystectomy and urinary diversion can be safely performed in older patients by experienced surgeons. Radical cystectomy appears to be a reasonable treatment strategy for properly selected elderly patients who are in generally good health and can benefit from definitive surgery for control of invasive bladder cancer. Radical cystectomy should not be routinely withheld because of a patient’s age. (Cancer, Vol 1, No 83, pp 141-147, 1998)