Radical Cystectomy Safe in Well-Selected Octogenarians, finds study
A new study published in the World Journal of Urology showed that after radical cystectomy, individuals 80 years of age and older who have a baseline health state similar to younger patients do not seem to be at higher risk of significant postoperative complications, short-term mortality, or hospital readmissions.
Managing complicated diseases like muscle-invasive bladder cancer in elderly persons is becoming more and more difficult as the world's population ages. The conventional therapy is radical cystectomy, but because of the perceived high risk of postoperative death, it is rarely administered to octogenarians. But new research indicates that comorbidities and biological fitness have a substantially greater influence on patient outcomes than age alone. Thus, this study compared the short-term mortality, complications, and readmission rates between younger surgery patients and octogenarians using a propensity-score-matched methodology.
This retrospective analysis of 879 patients who had open RC in a high-volume facility between 2015 and 2024. In order to balance patients under 80 years old and octogenarians (80–89 years old) for important factors such as ASA score, CCI score, BMI, renal function, preoperative albumin levels, and urine diversion, propensity score matching (PSM; 1:1 closest neighbor) was used. 30-day and 90-day mortality were the main outcomes. Major problems (Clavien-Dindo ≥IIIb) and readmission rates after 30 and 90 days were secondary objectives.
Octogenarians made up 114 (13%) of the 879 cases. Primary analyses showed that octogenarians had greater 30-day (6.1% vs. 1.4%; p = 0.003) and 90-day mortality (10.5% vs. 3.9%; p = 0.004) than those under 80. Following PSM (n = 194), mortality was numerically greater in octogenarians (30-day: 6.2% vs. 2.1%; 90-day: 10.3% vs. 4.1%); however, these differences were not statistically significant (p = 0.28 and p = 0.165).
Readmission and major complication rates were similar in matched cohorts. Age > 80 years was not an independent predictor of any unfavorable outcome in the multivariable regression analysis. The retrospective design, single-center setup, and small number of events after PSM are among the limitations.
Overall, octogenarians receiving RC show short-term results equivalent to younger patients when comorbidity burden and physiological fitness are comparable. RC should not be disregarded based just on chronological age. For elderly RC candidates to receive safe surgical care, individualized risk assessment, treatment at skilled, high-volume facilities, and probably growing use of robot-assisted RC are crucial.
Source:
Mangold, M. H., Egen, L., Carl, N., Renner, L. V., Studier-Fischer, A., Haney-Aubert, C. M., Wenk, M. J., Michel, M. S., Westhoff, N., & Kowalewski, K.-F. (2026). Radical cystectomy in octogenarians: a propensity score-matched analysis of short-term outcomes. World Journal of Urology, 44(1). https://doi.org/10.1007/s00345-026-06513-y
