Related Experiment Video
Updated: Jun 4, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Radical cystectomy in octogenarians: a propensity score-matched analysis of short-term outcomes
Maurin Helen Mangold1,2,3, Luisa Egen4, Nicolas Carl4
1Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim at Heidelberg University, Heidelberg, Germany. maurinhelen.mangold@umm.de.
Purpose:
This study aims to compare the impact of biological versus chronological age on postoperative risk after radical cystectomy (RC) by evaluating whether age ≥ 80 years independently predicts short-term mortality, complications and readmission rates beyond physiological status and comorbidity burden.
Methods:
We retrospectively analysed 879 patients undergoing open RC at a high-volume centre between 2015 and 2024. Propensity score matching (PSM; 1:1 nearest neighbor) was performed to balance octogenarians (80-89 years) and patients < 80 years for key covariates including ASA score, CCI score, BMI, renal function, preoperative albumin levels and urinary diversion. Primary endpoints were 30-day and 90-day mortality. Secondary endpoints included major complications (Clavien-Dindo ≥IIIb), 30- and 90-day readmission rates.
Results:
Among 879 patients, 114 (13%) were octogenarians. Primary analyses demonstrated a higher 30-day (6.1% vs. 1.4%; p = 0.003) and 90-day mortality (10.5% vs. 3.9%; p = 0.004) in octogenarians compared to patients < 80 years. After PSM (n = 194), mortality remained numerically higher in octogenarians (30-day: 6.2% vs. 2.1%; 90-day: 10.3% vs. 4.1%); however, these differences did not reach statistical significance (p = 0.28 and p = 0.165). Major complication and readmission rates were comparable between matched cohorts. In the multivariable regression analysis, age ≥ 80 years was not an independent predictor of any adverse outcome. Limitations include the retrospective design, single-centre setting and limited number of events after PSM.
Conclusion:
When comorbidity burden and physiological fitness are comparable, octogenarians undergoing RC achieve short-term outcomes similar to those of younger patients. Chronological age alone should not preclude consideration of RC. Individualised risk assessment, treatment in experienced, high-volume centres and most likely, increasing adoption of robot-assisted RC are essential for safe surgical care for older RC candidates.
