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 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: 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 2 patients ASA 2 23 patients ASA 2/3 6 patients 6 patients ASA 3 18 patients ASA 3/4 4 patients 4 patients ASA 4 1 patient 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 1x – 33 patients 2x – 15 patients 3x – 11 patients more than 3x – 8 patients MVAC 7 patients RTG - therapy 4 patients OER (open electroresection) 2 patients PBR (partial bladder resection) (partial bladder resection) 1 patient

Stage of the disease T0 1 patient T1m 7 patients T2a T2b 15 patients T3a 19 patients T3b 36 patients T4 48 patients Total 127 patients

Methods of urinary diversion. Bricker operation 46 patients Ileal neobladder 27 patients Transuretero-ureterostomy + nephrostomy 28 patients Ureterocutaneostomy 18 patients Mainz pouch II 3 patients Bilateral percutaneous nephrostomy 2 patients Transuretero- ureterocutaneostomy 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 injury2 patients Massive bleeding4 patients

Early complications after cystectomy. eventeration 10 patients bleeding 2 patients ileus 1 patient peritonitis 3 patients necrosis of uretero- intestinal anastomosis 1 patient pelvic abscess 1 patient lymphorhoea 5 patients pneumonia 6 patients

Early complications after cystectomy. thrombophlebitis 3 patients urinary fistula (leak of anastomosis) 2 patients respiratory failure 3 patients cardiac infarct 4 patients pulmonary embolism 1 patient Total 36 patients ( 28% )

Early complications after cystectomy. The first age group 22 patients The second age group14 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.