Radical cistectoniy in over 80 years old patients

Radical cistectomy is the only effective therapy of advanced bladder cancer. The treatment of old patients is still a challenge, for risk due to major surgery and prolonged anesthesia. We report our results on a group of 27 over 80 years old patients treated by radical cistectomy. From 1988 to 1995, we performed 201 radical cistectomy. 27 patients were more than 80 years old. Every patients of this group has a ASAC IV, except one (ASAC III). There was a high rate of BPCO (52% vs. 34% of the entire group) and ischemic miocardial disease (21% vs. 6%). To reduce the surgical time, as urinary diversion, in these patients we performed 18 ureterocutaneoustomies, 7 ileal conduits and 2 ureterosigmoidostomies. We did not record any intra-operatory or post surgery death. Also complicances are quite the same of youngest patients: one hemoperitoneum requiring laparotomy after two days from cistectomy. Medium post surgical hospitalization was the same of youngest patients. Radical cistectomy is well tolerated also in the old patient. Yet, there are some particular aspects, as cardiorespiratory and nutritional status, thath must be studied deeply before surgery. So, if the patient is well prepared, we think that the only remaining problem is the correct choice of urinary diversion to reduce the time of anesthesia, especially in those patients with sistemic disease.