CHIRURGIA DEL CARCINOMA VESCICALE NEL PAZIENTE ONCOLOGICO ANZIANO V. Serretta, C. Scalici Gesolfo, V. Messina Vol.2 (2017), issue 3, pag. 25-36
Accepted for pubblication
Although bladder cancer is a disease of the elderly, its management in patients older than 75 years remains controversial. Te curative treatment of muscle-invasive bladder cancer is radical cystectomy and elderly patients should not be withheld a potentially life-saving intervention only based on chronological age.
Only 20-25%% of patients older than 80 undergo cystectomy for a locally advanced bladder cancer, in spite of the severe risk of cancer progression and death if lef untreated. Besides diferences in health status, a poorer outcome of invasive bladder cancer in elderly might be explained by a suboptimal therapy. A multidisciplinary evaluation is needed to correctly assess the risks and benefts of the surgical treatment. In light of signifcant perioperative morbidity and mortality, a preoperative risk stratifcation is necessary to help the decision-making process and to correctly prepare the frail patient undergoing radical cystectomy. Less invasive surgery such as partial cystectomy if appropriate, extraperitoneal
cystectomy should be considered. Laparoscopic/robotic approach might be of beneft in selected cases but numbers are lacking. Te choice of the most appropriate urinary diversion is the key to obtain the higher beneft not only in terms of survival but also of quality of life. Ileal conduit is the most appropriate and used urinary diversion. It must be considered a lower rate of continence of orthotopic reservoir in elderly patients. Cutaneous ureterostomy may also represent a good surgical option in frail patients to limit the surgical risk with a
shorter hospital stay and lower complication rates.
Patients unsuitable to a major surgical approach may beneft of bladder-sparing approach.