Abstract
Objectives
Bladder cancer is the fourth more frequent tumour in men. Radical cystectomy is considered the standard treatment for muscle invasive bladder cancer (MIBC). However, its role in elderly patients is still debate. Management of MIBC in the elderly population is considered an important issue in urological practice for the continuous ageing of the European population. Aim of our study is to evaluate the feasibility and relatively morbidity and mortality of radical cystectomy in octogenarian patients affected by MIBC.
Methods
From 2005 to 2009, we performed in octogenarian patients (83–92 years), affected by MIBC, 30 radical cystectomy with mono or bilateral extraperitoneal terminal ureterocutaneostomy in regional anaesthesia (spinal anaesthesia). Pre-operative patients’ characteristics were evaluated with the American Society Anaesthesiologists score (ASA); peri- and post-operative complications were also recorded. Patients were revaluated at 3–6–9 months post-operatively with physical examination, serum analysis and ultrasound kidney scan.
Results
Radical cystectomy was always performed, median surgical time was 100 min (range 80–120 min), median blood replacement was 750 ml, and the overall morbidity rate was 13%. One patient died post-operatively. Median hospital stay was 8 days (range 5–12 days). Twenty-nine patients were alive at 9 months of follow-up.
Conclusion
Extraperitoneal radical cystectomy with ureterocutaneostomy could represent a feasible option, associated with a limited mortality and mobility, in the management of MIBC in octogenarian patients.
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References
Ferlay J, Autier P, Bonioli M, Heanue M, Colombet M, Boyle P (2007) Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 18(3):581–592
World Health Organization (WHO) (2007) Consensus conference in bladder cancer. In: Hautmann RE, Abol- Enein H, Hafez K et al. (eds) Urinary diversion. Urology 69(1 Suppl):17–49
Italian National Institute of Statistics, Demographics Italian population tables, http://www.Istat.it
Leibovitch I, Avigad I, Ben-Chaim J, Nativ O, Goldwasser B (1993) Is it justified to avoid radical cystoprostatectomy in elderly patients with invasive transitional cell carcinoma of the bladder? Cancer 71:3098–3101
Stroumbakis N (1997) Radical cystectomy in the octogenarian. J Urol 158:2113–2117
Figueroa AJ, Stein JP, Dickinson M et al (1998) Radical cystectomy for elderly patients with bladder carcinoma: an updated experience with 404 patients. Cancer 83:141–147
Stenzl A, Cowan NC, De Santis M et al (2009) The update EAU guidelines on: muscle-invasive and metastatic bladder cancer. Eur Urol 55:815–825
Glenn JF, Alyea EP (1960) Ureterocutaneous anastomosis. I. Experimental use of a surgical splint to prevent stricture. Trans Southeast Sect Am Urol Assoc 1959:36–39
Wood DP Jr (1987) Radical cystectomy for carcinoma of bladder in the elderly patient. J Urol 138(1):46–48
Crews DE, Zavotka S (2006) Aging, disability, and frailty: implications for universal design. J Physiol Anthropol 25:113–118
Studer E, Frohener M (2009) Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol 56(3):443–454
Harry HW (2001) Tour of invasive bladder tumour. J Clin Oncol 19:89–93
Goel A, Rao S, Bhagwat G, Vaidyanathan S, Goswami K, Sen K (1985) Intravesical irrigation with alum for the control of massive bladder haemorrhage. J Urol 133:956–957
Sarnak MJ, Long J, King AJ (1999) Intravesicular formaldehyde instillation and renal complications. Clin Nephrol 51:122–125
Joon-Ha Ok, Frederick J (2005) Medical and surgical palliative care of patients with urological malignancies. J Urol 174:1177–1182
Salminen E (1992) Unconventional fractionation for palliative radiotherapy of urinary bladder cancer. A retrospective review of 94 patients. Acta Oncol 31:449–454
Holmang S, Borghede G (1996) Early complications and survival following short-term palliative radiotherapy in invasive bladder carcinoma. J Urol 155:100–102
Deliveliotis C, Papatsoris A, Chrisofos M, Dellis A, Liakouras C, Skolarikos A (2005) Urinary diversion in high-risk elderly patients: modified cutaneous ureterostomy or ileal conduit ? Urology 66:299–304
Brausi M, Gavioli M, Peracchia G, DeLuca G, Viola M (2004) Radical cystectomy for invasive bladder cancer in patients 80 years old or older: clinical parameters affecting morbidity [abstract]. BJU Int 94(Suppl 2):16
Ubrig B, Lazica M, Waldner M, Roth S (2004) Extraperitoneal bilateral cutaneous ureterostomy with midline stoma for palliation of pelvic cancer. Urology 63:973–975
Stein JP, Quek ML, Skinner DG (2006) Lymphadenectomy for invasive bladder cancer. Techical aspects and prognostic factors. BJU International 97:232–237
Lance RS, Dinney CP, Swanson D et al (2001) Radical cystectomy for invasive bladder cancer in the octogenarian. Oncol Rep 8:723–726
Yamanaka K, Miyake H, Hara I, Inoue TA, Fujisawa M (2007) Significance of radical cystectomy for bladder cancer in patients over 80 years old. Int Urol Nephrol 39:209–214
Liguori G, Trombetta C, Pomara G et al (2007) Major invasive surgery for urologic cancer in octogenarians with comorbid medical conditions. Eur Urol 51:1600–1605
Mendiola FP, Zorn KC, Gofrit ON et al (2007) Cystectomy in the ninth decade: operative results and long-term survival outcomes. Can J Urol 14:3628–3634
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De Nunzio, C., Cicione, A., Leonardo, F. et al. Extraperitoneal radical cystectomy and ureterocutaneostomy in octogenarians. Int Urol Nephrol 43, 663–667 (2011). https://doi.org/10.1007/s11255-010-9876-7
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DOI: https://doi.org/10.1007/s11255-010-9876-7