Radical cystectomy for the management of muscle-invasive bladder cancer in the octogenarians: 10 years of a single institution experience

Pubblicato da il Mar 18, 2013 in | Commenti disabilitati su Radical cystectomy for the management of muscle-invasive bladder cancer in the octogenarians: 10 years of a single institution experience

==inizio abstract==

Objective
The aim of this report is to assess the oncologic outcome and POM of RC in a series of 65 elderly patients to highlight its feasibility as first-line treatment of MIBC.

Material and Methods
From September 2001 to October 2012 we identified sixty-five elderly patients (age 83-96) who underwent RC for
MIBC. Patients were categorized according to age, treatment intent and to the American
Society of Anesthesiologist classification (ASA). Primary endpoints to evaluate the technical feasibility and oncologic
outcome of RC were: operative time (OT), estimated blood loss (EBL), mean hospital stay (MHS), 3-5 yr overall (OS)
and disease-free (DFS) survival, 1 yr progression-free (PFS) survival. Secondary endpoints to assess POM related to
RC included: early (<90 days) and late (>90 days) complications according to Clavien Grading system; early and late overall mortality rate according to urinary diversion

Results
In the A group 5 yr OS and DFS were 48,8% and 51,1%
respectively. In the B group 3-years and 5-years OS was 41,6% and 16,6%, respectively. Estimated 1-year
progression-free survival (PFS) in the B group was 58,3%. Overall early complication was 58% , including 12,3%
Clavien I, 24,6% Clavien II, 12,3% Clavien III, 4,6% Clavien IV and 4,6 % Clavien V. Overall late complication was
25,8% including 6,4% Clavien II, 8% Clavien III, 8% Clavien IV and 3,2% Clavien V. Overall early and late mortality
were 4,6% and 3,2% respectively. Compared to ileal conduit, patients with bilateral cutaneous ureterostomy (UCS)
showed early and late complication of 4,6% and 3,2%, respectively.

Discussion
According to our series, UCS was the urinary diversion associated with less POM.

Conclusion
RC in the elderly, remains a complex procedure with significant
complications and mortality. UCS may represent a safe and feasible option for the treatment of MIBC in
ultraoctogenarians with high-risk comorbidities.

==fine abstract==