Transcript Radical Cystectomy in patients over 70

Radical cystectomy in
patients over 70
J.Sokołowski, T. Szydełko, P.Kowal, W.Kołaczyk,
J.Dembowski, W.Dobrucki, R.Zdrojowy, A.Kołodziej,
M.Fiutowski, M.Belda, K.Dudek, T.Niezgoda, J.Lorenz
Chair and Clinic of Urology Wroclaw Medical University
Jerzy Lorenz, Prof.,MD, PhD, Head of Clinic
WSS Urological Department in Wrocław
Jerzy Sokołowski,MD, PhD, Head of hospital department
Urological Department in Legnica
Wojciech Kołaczyk, MD, PhD, Head of hospital department
Radical cystectomy is
recognized as the golden
standard in the treatment of
invasive bladder tumours.
Cystectomy is a massive and
technically hard operation that
bears a high risk of early and
postoperative complications.
Thus the specification of particular
indications and contraindications
related to this procedure appears
to be tremendously important.
The age of the patient is one of
the factors that may have an
influence on the safety of
intervention.
There are many distempers of
intra-systemic balance in patients
over 70. Mainly,
they are related to :
cardio-vascular system
respiratory system
endocrine system
alimentary system.
The authors were trying to answer
the question whether the age of the
patient who underwent cystectomy
because of bladder cancer is a
crucial factor that has an influence
on the safety of the very
intervention and the number of
postoperative complications.
The age of 70 was agreed to
be the bordering measurement
taking into account that the
changes of the functioning of
cardio-vascular, respiratory,
endocrine and alimentary
systems are vividly increased at
this age.
Since 1996 till 2002
600 radical cystectomies
because of bladder cancer were
carried out in :
Clinic of Urology of Wroclaw
Medical University
WSS Urological Department in
Wrocław
Urological Department in
Legnica.
The results of the treatment of
127 patients were analysed.
All the interventions were performed with the
same operative technique.
Patients were divided into two age groups:
70-75 year olds (90 patients - 71%) and over
75 (37 patients - 29%).
The health condition of 54 patients was
estimated according to the scale of American
Anaesthesiology Association (ASA).
ASA 1/2
2 patients
ASA 2
23 patients
ASA 2/3
6 patients
ASA 3
18 patients
ASA 3/4
4 patients
ASA 4
1 patient
In 81 (63%) patients an attempt
was made to save the bladder
before finally cystectomy was
decided on.
Methods of treatment before
cystectomy.
TUR-BT
MVAC
RTG - therapy
OER
(open electroresection)
PBR
(partial bladder resection)
1x – 33 patients
2x – 15 patients
3x – 11 patients
more than 3x – 8 patients
7 patients
4 patients
2 patients
1 patient
Stage of the disease
T0
T1m
T2a
T2b
T3a
T3b
T4
Total
1 patient
7 patients
7 patients
15 patients
19 patients
36 patients
48 patients
127 patients
Methods of urinary diversion.
Bricker operation
Ileal neobladder
Transuretero-ureterostomy
+ nephrostomy
Ureterocutaneostomy
Mainz pouch II
Bilateral percutaneous
nephrostomy
Transureteroureterocutaneostomy
46 patients
27 patients
28 patients
18 patients
3 patients
2 patients
3 patients
Results
All the patients survived the operation
The average time of the operation was 4
hrs. 50 min.
The loss of the blood during the
intervention was, on average 1100 ml
Intraoperative complications
Rectum injury
2 patients
Massive bleeding
4 patients
Early complications after
cystectomy.
eventeration
10 patients
bleeding
2 patients
ileus
1 patient
peritonitis
3 patients
necrosis of ureterointestinal anastomosis
pelvic abscess
1 patient
lymphorhoea
5 patients
pneumonia
6 patients
1 patient
Early complications after
cystectomy.
thrombophlebitis
3 patients
urinary fistula (leak of
anastomosis)
respiratory failure
2 patients
cardiac infarct
4 patients
pulmonary embolism
1 patient
Total
36 patients ( 28% )
3 patients
Early complications after
cystectomy.
The first age group
22 patients
The second age group
14 patients
Reoperation was required in 18 patients
8 patients died after the operation
( 6,2% )
Heart infarct
4 patients
Pulmonary embolism
1 patient
Pneumonia
3 patients
Late postoperative complications
20 patients
The first age group
13 patients
The second age group
7 patients
Reoperation was required in 14 patients
Because of cancer
advancement 25 (19,6%)
patients died during the first 12
months of the postoperative
period. 21 more patients died
the following year.
Conclusions
The analysis of 127 cases of cystectomy
performed in patients over 70, has led us to
the conclusion that the method remains an
effective treatment of invasive cancer even
though the number of complications in that
age group is higher than in younger
patients.
Conclusions
The risk of complications
occurence rises with the age
of the patient and is
considerably higher in
patients over 75.