Extraperitoneal radical cystectomy and ureterocutaneostomy in octogenarians

Abstract

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. 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. 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. 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.