Orthotopic neobladder reconstruction in elderly bladder cancer patients

Abstract

Background: We compared the clinical results of orthotopic neobladder reconstruction in elderly patients and those in younger patients retrospectively in order to verify whether age is a critical factor in selecting a method of urinary diversion. Methods: Following radical cystectomy for bladder cancer, 12 patients aged 75 or older and 17 patients under 75 who underwent orthotopic neobladder reconstruction between January 1992 and May 1999 were investigated in this study. The authors TS and BS were among the surgeons who performed operations for all cases. Of the 12 elderly patients, orthotopic neobladders were constructed according to Hautmann's method in nine cases, Studer's method in one case and Reddy's method in two cases. Of the 17 younger patients, these methods were employed in 12, one and four cases, respectively. Operative procedure, early and late complications, prognosis, continence and voiding pattern were investigated in these patients. Results:The follow-up periods for elderly and younger groups ranged from 21.3 to 82.7 months and from 8.8 to 94.2 months, respectively. No difference in operation time, amount of bleeding or postoperative length of hospitalization was observed between elderly and younger patients. The rates of early complications in elderly and younger patients were 41.7% and 35.3%, respectively. Late complication rates were 33.3% and 47.1%, respectively. The difference in these complication rates was not statistically significant. One of the elderly and two of the younger patients had local recurrence and metastasis postoperatively. Those three patients had died of their bladder cancer. No statistically significant difference between groups was recognized in either cause-specific survival or overall survival, nor was there such a difference in relation to micturition/continence. Conclusion: Based on these results, we believe that because age is not a critical factor in the selection of urinary diversion method, neobladder reconstruction following cystectomy for bladder cancer is indicated in elderly patients. As stoma management is difficult for the patients, we consider orthotopic neobladder reconstruction to be the method of choice if the patients' general physical condition allows.

Laparoscopic versus Open Radical Cystectomy for Elderly Patients over 75-Year-Old: A Single Center Comparative Analysis

“…[9], [13], [23], [28], [29] The healthcare system is different between China and US, patients in our institution often comes from different provinces, it’s not convenient for patients to find an rehabilitation center for medical support after discharging from hospital, so most patients preferred to stay until all the tubes and sutures were removed even if they were fit for discharge in the LRC group. Hemal et al [30] and Saika et al [31] considered hospital stay was sometimes a reflection of health-care mode and the prevalent social condition of the patients. Overall survival rate is the golden standard to evaluate the feasibility of a medical intervention, it was observed that the LRC not only achieved less complication but also gained comparable overall survival (81% vs. 76%, P = 0.746) compared with ORC at a median follow-up of 21 months (range 3–61 months).…”

The feasibility of radical cystectomy in elderly patients

“…Perioperatif mortalite 30 günlük ve 90 günlük olmak üzere iki şekilde tarif edilmiştir. [7,[18][19][20][21] Çalışmamızda perioperatif mortalite ilk 30 gün olarak değerlendirilmiştir. Hasta grubumuzda perioperatif mortalite %3,9, komplikasyon %14,7 oranında gözlenmiştir.…”

Quality of Life and Overall Survival in High Risk Patients After Radical Cystectomy With a Simple Urinary Derivation

“…Another point of view was expressed by Saika et al, 16 who stated that age is not a determinant factor in the choice of the Clavien score Grade 1: any deviation of the normal postoperative course without need of pharmacological treatment or surgical, endoscopic or radiologic intervention. Treatments allowed include antiemetics, antipyretics, analgesics, diuretics, electrolytes and physiotherapy.…”