Radical cystectomy mortality in older patients: a systematic review and meta-analysis

Tempo, J; Felemban, S; Qin, KR; Perera, M; Ischia, J; Bolton, D; Murphy, DG; Kelly, B; Watson, DI; O&#39;Callaghan, M

Author(s): Tempo, J; Felemban, S; Qin, KR; Perera, M; Ischia, J; Bolton, D; Murphy, DG; Kelly, B; Watson, DI; O'Callaghan, M;
Details: Publication Year 2025-07,Volume 136,Issue #1,Page 19-31
Journal Title: BJU International
Publication Type: Review
Abstract: OBJECTIVE: To perform a systematic review and meta-analysis of post-radical cystectomy (RC) mortality and complications in older people to aid decision-making pertinent to RC, as bladder cancer is typically a disease of older people, yet older people are less likely than their younger peers to undergo RC, predominantly due to concerns about morbidity and mortality of surgery. MATERIALS AND METHODS: A systematic search of MEDLINE, Scopus and Ovid Emcare was performed in May 2023 for all studies in the past 20 years that reported mortality and/or complications in the 90-days following RC. All studies reporting mortality or complication outcomes in patient groups aged >75 years were included. Exclusion criteria included partial, or organ-sparing cystectomy, non-English language articles, and <20 patients aged >75 years. RESULTS: A total of 76 studies were included, with data from 58 504 older patients across five continents and 19 countries. Post-RC 90-day mortality was 11% in studies reporting outcomes for patients aged ≥80 years, and 7% in studies of patients aged ≥75 years. The 90-day mortality was higher in patients aged ≥80 years compared to patients aged <80 years (odds ratio [OR] 3.42, 95% confidence interval [CI] 1.62-7.22). Older people were more likely to experience a minor (Clavien-Dindo Grade I-II) postoperative complication than younger patients (OR 1.17, 95% CI 1.01-1.36), whereas there was no difference for major complications (Clavien-Dindo Garde III-IV; OR 1.00, 95% CI 0.63-1.60). A higher co-morbid status was more strongly correlated with 90-day mortality in older patients than in younger patients. CONCLUSIONS: Older patients face higher postoperative mortality following RC than younger patients. Postoperative outcomes should be weighed against the high risk of cancer-specific death if no curative treatment is offered. Older people must be monitored closely postoperatively to try and prevent death as a result of escalation from minor and major complications.
Publisher: Wiley
Keywords: Aged; Aged, 80 and over; Humans; Age Factors; *Cystectomy/mortality/methods; *Postoperative Complications/mortality; *Urinary Bladder Neoplasms/surgery/mortality; bladder cancer; cystectomy; morbidity; mortality; systematic review
Department(s): Surgical Oncology
Publisher's Version: https://doi.org/10.1111/bju.16733
Open Access at Publisher's Site: https://doi.org/10.1111/bju.16733
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-05-20 04:35:04

Last Modified: 2025-08-14 05:00:25