Editorial comment. Perioperative mortality is significantly greater in septuagenarian and octogenarian patients treated with radical cystectomy for urothelial carcinoma of the bladder.

摘要

The authors report their findings regarding the 90-day periop-erative mortality rates for patients undergoing cystectomy, stratifying their data according to age group (<70, 70-79, and >=80 years). Such information is an important initial step to a better understanding how patients fare after cystectomy. Data sets, such as the Surveillance, Epidemiology, and End Results database, are excellent means for constructing large, population-based samples. One disadvantage of such sources, however, is that they often lack data granularity (eg, patient comorbidities, American Society of Anesthesiologists classification, operative time, estimated blood loss, and intraoperative and postoperative complications) to better discern differences between groups. It seems that administrative data sets, although useful at times, might not provide the data necessary to more fully understand cystectomy outcomes. We are still lacking objective information to help us decide, on a patient-by-patient basis, who is an appropriate candidate for cystectomy. Most surgeons rely on clinical expertise and experience to make this decision. Even currently used approximations of individual patient surgical risk, such as the American Society of Anesthesiologists classification, rely on clinical judgment to assess a patient's suitability for radical cystectomy.