Age represents the main driver of surgical decision making in patients candidate to radical cystectomy.

Autor: Dell'Oglio P; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.; Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.; Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands., Tappero S; Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy.; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada., Panunzio A; Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy., Antonelli A; Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy., Salvador D; Department of Urology, Hospital Germans Trias i Pujol, Badalona, Spain., Xylinas E; Department of Urology, Medical University of Vienna, Vienna, Austria.; Department of Urology Cochin Hospital, APHP, Paris Descartes University, Paris, France., Alvarez-Maestro M; Servicio de Urología, Hospital Universitario La Paz, Madrid, España., Hurle R; Department of Urology, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy., Salas RS; Department of Urology, Institut Mutualiste Montsouris, Paris, France., Colomer A; Department of Urology, Institut Mutualiste Montsouris, Paris, France., Simone G; Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy., Hendricksen K; Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands., Peroni A; Department of Urology, ASST Spedali Civili, Brescia, Italy., Lonati C; Department of Urology, ASST Spedali Civili, Brescia, Italy., Olivero A; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Rouprêt M; Department of Urology, Pierre and Marie Curie Medical School, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Sorbonne, Paris, France., Roumiguié M; Department of Urology, Institut Universitaire du Cancer, Oncopole, Toulouse, France., Soria F; Department of Surgical Sciences, Division of Urology, Torino School of Medicine, AOU Città della Salute e della Scienza di Torino, Torino, Italy., Umari P; Division of Surgery and Interventional Sciences, University College London, London, UK., D'Andrea D; Department of Urology, Medical University of Vienna, Vienna, Austria., Terrone C; Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy., Galfano A; Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Moschini M; University Vita-Salute San Raffaele, Milan, Italy.; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Trapani ED; Division of Urology, IEO-European Institute of Oncology, IRCCS, Milan, Italy.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2023 Jul; Vol. 128 (1), pp. 142-154. Date of Electronic Publication: 2023 May 01.
DOI: 10.1002/jso.27255
Abstrakt: Background and Objectives: Age might influence the choice of surgical approach, type of urinary diversion (UD) and lymph node dissection (LND) in patients candidate to radical cystectomy (RC) for urothelial bladder cancer (UBC). Similarly, age may enhance surgical morbidity and worsen perioperative outcomes. We tested the impact of age (octogenarian vs. younger patients) on surgical decision making and peri- and postoperative outcomes of RC.
Methods: Non-metastatic muscle-invasive UBC patients treated with RC at 18 high-volume European institutions between 2006 and 2021 were identified and stratified according to age (≥80 vs. <80 years). Intraoperative Complications Assessment and Reporting with Universal Standards and European Association of Urology guidelines recommendations were accomplished in collection and reporting of, respectively, intraoperative and postoperative complications. Multivariable logistic regression models (MVA) tested the impact of age on outcomes of interest. Sensitivity analyses after 1:3 propensity score matching were performed.
Results: Of 1955 overall patients, 251 (13%) were ≥80-year-old. Minimally invasive RC was performed in 18% and 40% of octogenarian and younger patients, respectively (p < 0.001). UD without bowel manipulation (ureterocutaneostomy, UCS) was performed in 31% and 7% of octogenarian and younger patients (p < 0.001). LND was delivered to 81% and 93% of octogenarian and younger patients (p < 0.001). At MVA, age ≥80 years independently predicted open approach (odds ratio [OR]: 1.55), UCS (OR: 3.70), and omission of LND (OR: 0.41; all p ≤ 0.02). Compared to their younger counterparts, octogenarian patients experienced higher rates of intraoperative (8% vs. 4%, p = 0.04) but not of postoperative complications (64% vs. 61%, p = 0.07). At MVA, age ≥80 years was not an independent predictor of length of stay, intraoperative or postoperative transfusions and complications, and readmissions (all p values >0.1). These results were replicated in sensitivity analyses.
Conclusions: Age ≥80 years does not independently portend worse surgical outcomes for RC. However, octogenarians are unreasonably more likely to receive open approach and UCS diversion, and less likely to undergo LND.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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