Objective: We have reviewed our surgical experience to assess intra– and postoperative morbidity and mortality in 25 patients 75 years old or older with invasive bladder cancer who underwent radical cystectomy and urinary diversion or bladder substitution. Methods: Between January 1993 and February 1999, of 190 patients who underwent 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 substitution in 2. All patients had significant comorbidity and 15 patients were ASA II and 10 ASA III. 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. The most common late complication was ureteroileal anastomotic stricture (16%). The median hospital stay and intensive care unit stay were 24 and 14 days, respectively. With a median follow–up of 14 (5–50) months the overall mortality rate was 32%. Conclusions: Radical cystectomy can be performed in elderly patients with acceptable perioperative mortality and morbidity. However, because of the high incidence of minor medical complications, hospital stay is often prolonged.

Keywords:
Radical cystectomy, Bladder carcinoma, Elderly patients, Complications
1.
Les hommes et les femmes. Condensé de l’Annuaire Eurostat; in Communautés européennes. Luxembourg, Office des publications officielles des communautés européennes, 1998, pp 2–9.
2.
Ménegoz F, Cherié–Challine L: Le cancer en France: Incidence et mortalité. Situation en 1995. Evolution entre 1975 et 1995. Cancer de la vessie. Paris, Documentation Française, 1998, pp 106–111.
3.
Berlié J: Epidémiologie du cancer chez les personne âgées. Oncologica 1992;4:9–14.
4.
Rischmann P, Bittard H, Chopin D, Coloby P, Davin JL, Irani J, Lebret T, Lefrere MA, Maidenberg M, Maréchal JM, Pariente JL, Théodore C: Recommendations du Comité de Cancérologie de l’Association Française d’Urologie. Tumeurs urothéliales. Prog Urol 1998;8:25–32.
5.
Figureora AJ, Stein JP Dickinson M, Skinner EC, Thanga Thurai D, Mikhail MS, Boyd SD, Lieskovsky G, Skinner DG: Radical cystectomy for elderly patients with bladder carcinoma. An uptdate experience with 404 patients. Cancer 1998;83:141–147.
6.
Skinner EC, Lieskovsky G, Skinner DG: Radical cystectomy in the elderly patient. J Urol 1984;131:1065–1068.
7.
Stroumbakis N, Herr HW, Cookson MS, Fair WR: Radical cystectomy in the octogenarian. J Urol 1997;158:2113–2117.
8.
Wood DP, Montie JE, Maatman TJ, Beck GJ: Radical cystectomy for carcinoma of the bladder in the elderly patient. J Urol 1987;138:46– 48.
9.
Zincke H: Cystectomy and urinary diversion in patients eighty years old or older. Urology 1982;19:139–142.
10.
Zingg EJ, Bornet B, Bishop MC: Urinary diversion in the elderly patient. Eur Urol 1980;6: 347–351.
11.
Keats AS: The ASA classification of physical status. A recapitulation. Anesthesiology 1978; 49:233–238.
12.
Roca R: Psychosocial aspects of surgical in the elderly patients. Surg Clin North Am 1994;74: 223–243.
13.
Levkoff SE, Evans DA, Liptzin B, Cleary PD, Lipsitz LA, Wetle TT, Reilly CH, Pilgrim DM, Schor JD, Rowe J: Delirium: The occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med 1992; 152:334–340.
14.
Schor JD, Levkoff SE, Lipsitz LA, Reilly CH, Cleary PD, Rowe J, Evans DA: Risk factors for delirium in hospitalized elderly. JAMA 1992;267:827–831.
15.
Brandsteller RD, Kazemi H: Aging and the respiratory system. Med Clin North Am 1983; 67:419–431.
16.
Djokovic JL, Hedley–Whyte J: Prediction of outcome of surgery and anesthesia in patients over 80. JAMA 1979;242:2301–2306.
17.
Raghavan D: Management of advanced bladder cancer in the elderly. Urol Clin North Am 1992;19:797–806.
18.
Nitti VW, Macchia RJ: Bladder cancer in geriatric patients. Alternatives to radical cystectomy. Clin Geriatr Med 1990;6:173–184.
2001
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