RADICAL CYSTECTOMY (RC) IN OCTOGENARIANS : LONG-TERM EXPERIENCE OF TWO HIGH VOLUME INSTITUTIONS

INTRODUCTION AND OBJECTIVES: The objectives of the study were to evaluate morbidity, overall survival (OS) and disease specific survival (DSS) of radical cystectomy (RC) in octogenarians in two urological centers METHODS: From 2000 to 2012, 1010 pts with in filtrative or recurrent high grade T1 TCC of the bladder received RC and urinary diversion in 2 italian institutions. 170/1010 patients (16.8%) were 80 years old or older. The mean age was 83.2 years: M/F: 128/42. ASA score was used for classifying preop. risk. ASA 2: 56/170 (33%),ASA 3: 75/170 (44.1%), ASA 4 : 39/170 (23%).113/170 pts.(66.5%) received uretero-cutaneostomy (UCS) as a diversion while 42/170 (25%) had Bricker, 14/170 pts (8.3%) had an orthotopic neobladder, 1/170 pt. had an ureterosigmoidostomy(0.5%).P stage was: T0 : 1 Pt (0.5%). Tis+Ta- T1: 25/170 pts (14.7%); T2b:35/170 (20.6%);T3a: 32/170 (19%); T3b: 45/170 (26.5%); T4: 32/170 (19%).Grade. G3:153/170 pts (90%), G2:17/170 (10%).33 pts. did not received pelvic lymph adenectomy (salvage RC). 29/137 pts (21%) were N+(pT3-T4). 125/170 pts (73.5%) were in intensive care Unit (ICU) for 1-6 days. 81/170 pts (47.6%) were transfused. The average blood unit received was 3.5 U. RESULTS: The mean follow-up was 44.5 months (21-118 months).Peri operative mortality was 7.6% (13/170).Mean hospital stay was 14.5 days (7-35 days). The complication rate (medical and surgical) was 43%.8.3% of patients required a second operation.Medical and surgical complications by ASA were: ASA2¼ 11.8%, ASA 3¼ (50%),ASA4¼ 38% respectively.The medical complication rate by surgicalapproach: extraperitoneal¼40.4%, peritoneal¼ 27%;surgical compli-cation rate : extraperitoneal route¼12.8%,trans-peritoneal approach¼30% (p<0.001). Complication rate by diversion: UCS¼26% Bricker¼49.2%, Orthotopic¼45% (p<0.001). OS: After 1 year ¼60%, 2 years¼43.6%, 3 year¼40% . DSS was 63.3% at 1 year, 51.2% at 2 yearsand 50% after 3 years. . CONCLUSIONS: The results of our study support the use of RC in octogenarians. Mortality and complications were acceptable. Mayor complications were correlated with high ASA score (3-4), type of urinary diversion (Bricker) and surgical approach ( intraperitoneal).