Radical cystectomy for invasive bladder carcinoma in patients 75 years old or older

Between 1995 and 2004, 43 patients underwent radical cystectomy and urinary diversion for the treatment of invasive bladder cancer at our institution. Of these patients, seven who were 75 years old or older, were considered elderly. Survival and treatment outcome of these patients were compared to younger counterparts stratified into three groups by age at diagnosis (12 patients younger than 64, 12 patients 65 to 69 years, and 12 patients 70 to 74 years). Preoperative morbidity was encountered in 57% of the elderly patients, and 42% of the elderly patients had two or more complications. There was one operative death (14%) among the elderly patients but no such deaths in the 3 younger groups. The postoperative complication rate for patients age 75 years or older was 86%, compared to 75% for patients younger than 64, 75% for those age 65 to 69 and 83% for those age 70-74. The prevalence did not differ significantly between the older and youger patients. There were no cancer deaths among the elderly patients, but 8 of the 36 younger patients died of cancer. The cancer-specific 5-year survival rate was 100% at 34 months in the elderly population. These findings suggest that radical cystectomy and urinary diversion is a relatively safe procedure and a curative operation is worth attempting in elderly patients with invasive bladder cancer, if they are in generally good health.