ABSTRACT
Background
Studies about perioperative complications and all-cause mortality in frail patients
requiring radical cystectomy (RC) are scarce. We aimed to assess the short- and long-term
effect of RC in frail patients with bladder cancer.
Patients and Methods
We performed a retrospective, cohort study including patients who underwent open RC
due to bladder cancer from November 2013 to June 2022. Patients were considered frail
when they fulfilled one of the following criteria: i) age ≥ 75 years; ii) Charlson
Comorbidity Index ≥ 9; iii) American Society of Anesthesiologists classification ≥
4; or iv) Clinical Frailty Scale score ≥ 5. We evaluated all-cause mortality and complications
in frail versus non-frail patients. The effect of urinary diversion with ileal conduit
versus ureterocutaneostomy in frail patients was also assessed via a cox regression
analysis.
Results
Overall, 184 individuals underwent RC (95 frail and 89 non-frail). A total of 130
patients (80%) presented at least one perioperative complication. This proportion
was even higher among frail patients (86%). Similarly, severe perioperative complications
were more common in frail patients based on the Clavien-Dindo classification (p=0.044).
Regarding disease progression and long-term complications, no statistically significant
differences were observed between frail and non-frail patients. The survival analysis
with Kaplan-Meier curves demonstrated that the risk of death was increased in frail
patients (log-rank test=0.027). Based on the multivariate Cox regression analysis
adjusting for major risk factors, urinary diversion with ureterocutaneostomy was significantly
associated with increased mortality in frail patients compared to ileal conduit (Hazard
Ratio: 3.5, 95% Confidence Interval: 1.3-9.4, p=0.01).
Conclusions
RC is feasible in frail patients but is associated with increased perioperative morbidity
and mortality. Preoperative frailty screening should be implemented to counsel and
carefully select patients eligible for RC.
Micro Abstract
Studies about perioperative complications and all-cause mortality in frail patients
requiring radical cystectomy (RC) are scarce. In this retrospective cohort study we
identified individuals underwent RC (95 frail and 89 non-frail). RC in frail patients
was associated with increased mortality and morbidity but it remains a feasible option.
Keywords
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Article info
Publication history
Accepted:
March 7,
2023
Received in revised form:
March 6,
2023
Received:
September 4,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
