Premium
Radical cystectomy mortality in older patients: a systematic review and meta‐analysis
Author(s) -
Tempo Jake,
Felemban Sulleyman,
Qin Kirby R.,
Perera Marlon,
Ischia Joseph,
Bolton Damien,
Murphy Declan G.,
Kelly Brian,
Watson David I.,
O’Callaghan Michael
Publication year - 2025
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.16733
Subject(s) - cystectomy , medicine , meta analysis , odds ratio , confidence interval , bladder cancer , complication , medline , systematic review , surgery , cancer , political science , law
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.