Efficacy and safety of radical cystectomy with ileal conduit for muscle-invasive bladder cancer in the elderly: a multicentre retrospective study

Objective: Radical cystectomy with ileal conduit is the current mainstay of treatment for muscle-invasive bladder cancer and is also a high-risk procedure. Existing studies have limited targeted assessment of the efficacy and safety of this procedure, and the patient population appropriate for this procedure is poorly defined. We sought to longitudinally analyze differences in the efficacy and safety of radical cystectomy with ileal conduit by age subgroups to assess whether the age factor should be used as an exclusion criterion when selecting this procedure. Materials and Methods: Clinicopathological data of patients with muscle-invasive bladder cancer who underwent radical cystectomy with ileal conduit at the Cancer Hospital of Harbin Medical University from February 2014 to October 2023 were used to retrospectively analyze the efficacy and safety of the surgical procedure. Pathological clinical data of patients diagnosed with muscle-invasive bladder cancer in the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2020 were used for external validation. information was used for external validation of the results of the surgical efficacy analyses. t-tests and non-parametric tests were used to analyze the measurement data, chi-square tests were used to analyze the count data, and Kaplan-Meier was used for the survival analyses and to plot survival curves. Results: Define patients aged ≥70 at the time of diagnosis of bladder cancer as elderly patients and <70 as non-elderly patients. 152 patients from our center were included in the study, 119 non-elderly patients and 33 elderly patients. 416 patients from the Seer database were used for validation, 172 patients in the non-elderly group and 244 patients in the elderly group. By overall analysis and subgroup analysis, the results showed that elderly patients had a higher risk of ICU transfer but a smaller incidence of stoma inflammation postoperatively. Meanwhile, although the results of both analyses of overall survival (OS) for the two groups of patients were conflicting, data from our center and data from the SEER database confirmed the consistency of cancer-specific survival (CSS) between elderly and non-elderly patients, and that radical cystectomy with ileal conduit had the same efficacy for both elderly and non-elderly patients. Conclusion: For longitudinal age subgroups, radical cystectomy ileocecal cystectomy for the treatment of elderly versus nonelderly muscle-invasive bladder cancer has consistent efficacy, and the generalisability of the results for elderly patients, despite the risks of surgery, needs to be further validated in targeted cohort studies. Advanced age should not be an absolute exclusion criterion for radical cystectomy with ileal conduit.