One-stage total cystectomy and ileal loop diversion in patients over eighty years' old with bladder carcinoma. Pre- and postoperative functional reserve of various organs.
During the period from 1976 to 1981, 364 patients with bladder carcinoma were seen at the Keio University Hospital. Extensive preoperative investigation of pulmonary, cardiovascular, and renal function was obtained in all patients. Of the 12 patients studied, 9 underwent a one-stage total cystectomy and ileal loop diversion and the remaining 3 a two-stage procedure. Of the 9 patients, decreased FEV 1.0 per cent by spirometry was noted in 5, ECG abnormality such as bundle branch blocks in 8, and diminished creatinine clearance ranging from 28 to 68 ml/min were observed in all 9. Major postoperative complications included pyelonephritis in 2 patients, pneumonia in 1, pelvic abscess in 2, renal insufficiency in 3, and paralytic ileus in 2. There was no immediate postoperative death. In these elderly patients, functional reserve of the lung, heart, and kidney is less than optimal and is further decreased by major surgical procedures. Therefore, total cystectomy in the elderly patients is justifiable only in a selected group of patients, when functional status of the vital organ is thoroughly worked up and prophylactic and therapeutic measures are instituted promptly if indicated.
D000368:Aged; D002277:Carcinoma / Q000503:physiopathology / Q000601:surgery*; D006321:Heart / Q000503:physiopathology; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007668:Kidney / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology; D011183:Postoperative Complications / Q000503:physiopathology; D011184:Postoperative Period; D011379:Prognosis; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion