Introduction:

Octogenarians with muscle invasive bladder cancer derive oncologic benefit from definitive local therapy yet present a challenge because of increased risks of surgical complications.  We reviewed the clinical profile of octogenarians undergoing radical cystectomy in the United States and compared perioperative outcomes to younger patients.

Methods:

We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2012 to 2016 and identified patients with a diagnosis of bladder cancer undergoing radical cystectomy.  We identified the subset of patients at least 80 years old and assessed the preoperative clinical profile and 30-day complications. Frailty was estimated by the modified frailty index (functional status, diabetes, chronic obstructive pulmonary disorder, history of chronic heart failure, and hypertension requiring medication.) Demographic and perioperative outcomes were compared to those of younger patients utilizing Chi-Square analyses for categorical variables, student’s t tests for means, and the Wilcoxon rank sum test for operative time and length of stay (LOS).

Results:

4,680 patients including 617 (15.2%) 80 years or older were identified.  Of octogenarians, age was 82.8 +/- 2.3 years, 469 (76%) were male and 499 (80.9%) were Caucasian.  148 (24%) were obese (BMI 30+). [Table 1] Despite significant differences in average ASA score (2.96 vs 2.78, p<0.0001) and frailty, octogenarians experienced similar rates of minimally-invasive approach to cystectomy (p=NS).  Compared to younger patients, octogenarians had longer LOS (8 vs. 7 days, p <0.0001), lower discharge to home (70.66% vs. 87.97%, p = <0.001) higher mortality (3.73% vs 1.72%, p=0.0009) and more major complications (Clavien 3-5) (17.51% vs. 16.39%). Re-operation (4.7% vs. 5.91%, p=0.23) and hospital readmission (21.56% vs. 20.79%, p=0.660) were similar. [Table 2]

Conclusion:

Octogenarians comprise a substantial number of cystectomies for bladder cancer in the United States.  The cohort had worse 30-day outcomes than younger patients, but differences were relatively limited and not seen across all parameters.  The data supports the role of surgery in appropriately selected and counseled octogenarians.

Funding: N/A