Evaluation of Functional Outcomes and Quality of Life in Elderly Patients (>75 y.o.) Undergoing Minimally Invasive Radical Cystectomy with Single Stoma Ureterocutaneostomy vs. Bricker Intracorporeal Ileal Conduit Urinary Diversion.

Andrea Fuschi,Alessandro Zucchi,Gennaro Velotti,Anastasios Asimakopoulos,Paolo Pietro Suraci,Antonio Luigi Pastore,Antonio Carbone,Cosimo De Nunzio,Giorgio Bozzini,Silvio Scalzo,Manfredi Bruno Sequi,Yazan Al Salhi,Alessia Martoccia

doi:10.3390/jcm11010136

Abstract

Background: Diversion after radical cystectomy (RC) is crucial when considering elderly subjects. Data on the quality of life (QoL) impact with different diversions is scarce. This study aims to compare complications and QoL in patients aged > 75 y.o., who underwent minimally invasive (MI) RC with Bricker intracorporeal urinary derivation and single stoma ureterocutaneostomy. Methods: We conducted a retrospective analysis of elderly patients who underwent MIRC and intracorporeal diversion. The 78 subjects were divided into two groups: group A, ileal conduit, and group B, single stoma ureterocutaneostomy. We evaluated the bowel’s recovery time and complications rate. We investigated QoL 3 and 6 months after surgery using the Stoma-QoL questionnaire. Results: Mean age was 77.2 in group A and 82.4 in group B. The mean ASA score and Charlson Comorbidity index were comparable between the two groups. Rates of complications were 57.6% and 37.4% in groups A and B, respectively. The mean postoperative Stoma-QoL score 3 months after surgery was 52.2 and 52.4 in groups A and B, respectively. At 6 months of follow-up the Stoma QoL mean score was 63.4, showing homogeneity between the groups. Conclusion: MIRC with single stoma ureterocutaneostomy represents an alternative to ileal conduit, with comparable QoL and ostomy management 6 months after surgery, reporting fewer complications.

Highlights

Radical cystectomy (RC) with lymphadenectomy represents the “gold standard” treatment for muscle-invasive and selected high-risk non-muscle-invasive bladder cancer [1–3]
This study aims to compare perioperative and postoperative complications and quality of life (QoL) in two groups of patients aged > 75 and in a high comorbidity state, who underwent minimally invasive radical cystectomy with intracorporeal ileal conduit (Bricker) or single stoma ureterocutaneostomy
The study was conducted as a retrospective analysis of the medical records of patients with muscle-invasive bladder cancer (MIBC) and high-risk non-muscle-invasive bladder cancer (NIMBC), who underwent laparoscopic or robot-assisted radical cystectomy (RC) with intracorporeal ileal conduit or single stoma ureterocutaneostomy

Summary

Introduction

Radical cystectomy (RC) with lymphadenectomy represents the “gold standard” treatment for muscle-invasive and selected high-risk non-muscle-invasive bladder cancer [1–3]. Ureterocutaneostomy (UCS) can be performed quickly, significantly reducing operative time and the potential risk of intestinal and metabolic complications compared to the ileal conduit. This is an essential factor to consider when evaluating geriatric patients with advanced disease and limited life expectancy [2]. This study aims to compare perioperative and postoperative complications and QoL in two groups of patients aged > 75 and in a high comorbidity state, who underwent minimally invasive (laparoscopic or robot assisted approach) radical cystectomy with intracorporeal ileal conduit (Bricker) or single stoma ureterocutaneostomy. Conclusion: MIRC with single stoma ureterocutaneostomy represents an alternative to ileal conduit, with comparable QoL and ostomy management 6 months after surgery, reporting fewer complications

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