Radical cystectomy in patients older than 75 years: Assessment of morbidity and mortality

Objective: We have reviewed our surgical experience to assess intra- and po stoperative morbidity and mortality in 25 patients 75 years old or older wi th invasive bladder cancer who underwent radical cystectomy and urinary div ersion or bladder substitution. Methods: Between January 1993 and February 1999, of 190 patients who underw ent radical cystectomy, 23 men and 2 women were aged from 75 to 87 (median 79) years. Urinary diversion was performed in 23 cases and bladder substitu tion in 2. All patients had significant comorbidity and 15 patients were AS A II and 10 ASA Ill. Results: Median operating time was 4 h. Perioperative mortality rate was 4% . Intraoperative, early and late postoperative complications occurred in 15 , 16 and 6 patients, respectively. The most common early complications were pyelonephritis (32%), disorientation (20%), additional pulmonary infection (20%) and prolonged ileus (32%). No secondary procedures were necessary. T he most common late complication was ureteroileal anastomotic stricture (16 %). The median hospital stay and intensive care unit stay were 24 and 14 da ys, respectively. With a median follow-up of 14 (5-50) months the overall m ortality rate was 32%. Conclusions: Radical cystectomy can be performed in elderly patients with a cceptable perioperative mortality and morbidity, However, because of the hi gh incidence of minor medical complications, hospital stay is often prolong ed. Copyright (C) 2001 S. Karger AG, Basel.