[Mortality and morbidity of radical cystectomy for bladder cancer in patients over the age of 75].

OBJECTIVE

The objective of this study was to evaluate the mortality and morbidity of cystectomy and the functional results of the associated diversions in patients over the age of 75 operated for bladder cancer.

MATERIAL AND METHODS

From 1988 to 2002, 37 patients (29 men and 8 women) aged between 75 to 88 years (median: 79 years) underwent radical cystectomy for bladder cancer. All patients had at least one comorbidity factor, 17 patients were classified as ASA II (45.9%) and 20 were classified as ASA III and IV (54.1%). An external urinary diversion was performed in 35 patients and orthotopic bladder replacement was performed in two patients. The mean follow-up was 21.0 months (range: 0.3-88.6). The mortality, early and late morbidity, and functional results were analyzed.

RESULTS

There was no intraoperative mortality and the early mortality rate was 5.4% (2/37). The early medical morbidity rate was 24.3%, essentially cardiovascular (pulmonary embolism, myocardial infarction, pulmonary edema), and the early surgical morbidity rate was 2.7%. The late morbidity rate was 27.0%, essentially corresponding to wound complications (peristomal or midline incisional hernias). In terms of functional results, a peristomal incisional hernia with stoma appliance difficulties was observed in 11.4% of patients with an external diversion. One of the two patients treated by bladder replacement performed intermittent self-catheterization and the other was continent during the day and required pads at night.

CONCLUSION

This study shows that the acceptable mortality and early and late morbidity results allow radical cystectomy to be proposed in patients over the age of 75.