The Motion: Radical Cystectomy in the Elderly is Becoming a Standard Treatment for Bladder Cancer

The current standard treatment for nonmetastatic invasive bladder cancer is radical cystectomy with urinary diversion. Radical cystectomy surgery carries a serious potential risk of complications. In this case report, an intestinal perforation which was thought to be occurred due to a Foley catheter placed as a drain after the cystectomy is presented.

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MP2-03 RADICAL CYSTECTOMY AND ADJUVANT CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER IN THE ELDERLY: A POPULATION-BASED STUDY

The Journal of Urology ◽

10.1016/j.juro.2014.02.161 ◽

2014 ◽

Vol 191 (4S) ◽

Author(s):

Michael Leveridge ◽

Robert Siemens ◽

William Mackillop ◽

Yingwei Peng ◽

David Berman ◽

...

Keyword(s):

Bladder Cancer ◽

Adjuvant Chemotherapy ◽

Radical Cystectomy ◽

The Elderly ◽

Population Based ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Population Based Study ◽

Muscle Invasive

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1089 FEASIBILITY AND OUTCOMES OF ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL CYSTECTOMY FOR BLADDER CANCER IN THE ELDERLY

The Journal of Urology ◽

10.1016/j.juro.2010.02.2286 ◽

2010 ◽

Vol 183 (4S) ◽

Author(s):

Matthew Raynor ◽

Stephen McKim ◽

Eugene Simopoulos ◽

Matthew Nielsen ◽

Eric Wallen ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

The Elderly ◽

Robotic Assisted

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Complications Following Radical Cystectomy for Bladder Cancer in the Elderly

European Urology ◽

10.1016/j.eururo.2009.05.008 ◽

2009 ◽

Vol 56 (3) ◽

pp. 443-454 ◽

Cited By ~ 173

Author(s):

Michael Froehner ◽

Maurizio A. Brausi ◽

Harry W. Herr ◽

Giovanni Muto ◽

Urs E. Studer

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

The Elderly

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Is Robot-Assisted Radical Cystectomy Justified in the Elderly? A Comparison of Robotic Versus Open Radical Cystectomy for Bladder Cancer in Elderly ≥75 Years Old

Journal of Endourology ◽

10.1089/end.2012.0035 ◽

2012 ◽

Vol 26 (10) ◽

pp. 1301-1306 ◽

Cited By ~ 39

Author(s):

Kyle A. Richards ◽

A. Karim Kader ◽

Rick Otto ◽

Joseph A. Pettus ◽

John J. Smith ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

The Elderly ◽

Robot Assisted ◽

Open Radical Cystectomy

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FEASIBILITY AND OUTCOMES OF ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL CYSTECTOMY FOR BLADDER CANCER IN THE ELDERLY

The Journal of Urology ◽

10.1016/s0022-5347(09)61029-6 ◽

2009 ◽

Vol 181 (4S) ◽

pp. 363-363

Author(s):

Jeff Nix ◽

Matthew Coward ◽

Angela Smith ◽

Raj Kurpad ◽

Matthew Nielsen ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

The Elderly ◽

Robotic Assisted

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An analysis of preoperative delays prior to radical cystectomy forbladder cancer in Quebec

Canadian Urological Association Journal ◽

10.5489/cuaj.482 ◽

2013 ◽

Vol 2 (2) ◽

pp. 102 ◽

Cited By ~ 6

Author(s):

Nader Fahmy ◽

Wassim Kassouf ◽

Suganthiny Jeyaganth ◽

Moamen Amin ◽

Salaheddin Mahmud ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Standard Treatment ◽

Bladder Tumour ◽

Surgical Volume ◽

Poor Survival ◽

Case Selection ◽

Included Patient ◽

Increased Risk ◽

Age And Sex

Background: The province of Quebec has the highest incidence of urothelialtumours in Canada. Radical cystectomy remains the standard treatment for invasivebladder cancer. We have previously observed that prolonged delays betweentransurethral resection of bladder tumour (TURBT) and radical cystectomy leadto worse survival in Quebec.Objective: The aim of our study was to characterize the various periods of delaysustained by bladder cancer patients before radical cystectomy across Quebecand to determine their relation to survival.Methods: We obtained the billing records for all patients treated with radicalcystectomies for bladder cancer across Quebec from 1990 to 2002. Collectedinformation included patient age and sex; dates of family physician (FP) andspecialist visits with accompanying diagnoses; dates of cystoscopy, TURBT andCT scanning; surgeon age; surgical volume and dates of death.Results: We analyzed a total of 25 862 visits for 1633 patients. Median diagnosticdelays from FP to specialist, then to cystoscopy, then to TURBT and finallyfrom TURBT to CT were 20, 11, 4 and 14 days, respectively, over the entirestudy period. Median overall delay from FP visit to radical cystectomy was93 days. In addition, median FP to radical cystectomy delay progressivelyincreased from 1990 to 2000 from 58 to 120 days (p < 0.01). Multivariate analysesshowed that patients with an overall delay of either < 25 or > 84 dayshad a 2.1 and 1.4 times increased risk of dying, respectively (p ≤ 0.01).Conclusion: Preoperative delays have been progressively increasing over time.Overall, delays from FP to radical cystectomy of < 25 and > 84 days may translateinto worse outcomes. Poor survival in cases with < 25 days delay maybe attributed to case selection, with more advanced cases being managed muchquicker. Poor survival in cases with delays of > 84 days may be attributed todisease progression while awaiting completion of management.

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Clinical-pathologic stage discrepancy in patients with bladder cancer treated with radical cystectomy: Associations with clinical variables and survival.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.248 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 248-248 ◽

Cited By ~ 2

Author(s):

Phillip J. Gray ◽

Stacey A. Fedewa ◽

William U. Shipley ◽

Chun Chieh Lin ◽

Katherine S. Virgo ◽

...

Keyword(s):

Bladder Cancer ◽

Lymph Nodes ◽

Radical Cystectomy ◽

Proportional Hazards Model ◽

The Elderly ◽

The United States ◽

Cox Proportional Hazards Model ◽

Extended Lymphadenectomy ◽

Cancer Data ◽

Pathologic Stage

248 Background: Radical cystectomy (RC) is the most common treatment for bladder cancer (BC) in the United States. We examined clinical-pathologic stage discrepancy using the National Cancer Data Base. Methods: 16,953 patients with BC treated with RC between 1998 and 2009 were analyzed. Clinical factors associated with stage discrepancy were assessed by multivariable generalized estimating equation models. Survival analysis was conducted for patients treated between 1998 and 2004 (N=7,270) using a Cox proportional hazards model. Results: 41.9% of patients were upstaged at RC while 5.9% were downstaged. Upstaging was more common in females (OR 1.08, p=.04), the elderly (OR 1.26 for age ≥80 vs. 18-59, p=.001), higher tumor grade (OR 2.29 for grade 3-4 vs. grade 1, p<.0001), non-urothelial histology (OR 1.31, p=.002 for squamous and OR 1.26, p=.03 for adenocarcinoma), and with extended lymphadenectomy (OR 1.27 for ≥10 lymph nodes examined vs. 0-9, p<.0001). Downstaging was less common in the elderly (OR 0.50 for age ≥80 vs. 18-59, p<.0001), in Hispanics (OR 0.58, p=.009) and with variant histology (OR 0.55, p=.003 for squamous and OR 0.3, p<.0001 for adenocarcinoma). Receipt of neoadjuvant chemotherapy (CT) was highly associated with downstaging (OR 2.31, p<.0001). 5-year survival by stage is shown in the table. Upstaging was associated with increased 5-year mortality (HR 1.79, p<.0001) as was receipt of CT (HR 1.28, p=.02 for neoadjuvant and HR 1.23, p<.0001 for adjuvant). Extended lymphadenectomy was associated with decreased 5-year mortality (HR 0.82 for ≥10 lymph nodes examined vs. 0-9, p<.0001). Downstaging was not associated with survival (HR 0.88, p=0.17). Conclusions: This study is the largest to date to analyze stage discrepancy and survival in BC patients treated with RC. Upstaging is common and is associated with decreased 5-year survival. These data can be used in pre-operative risk stratification, treatment decision making and comparison with studies of non-operative management. [Table: see text]

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