title: Peri-operative management of ablative and reconstructive surgery for invasive bladder cancer in the elderly.
abstract: OBJECTIVE
  Radical cystectomy and urinary diversion for muscle invasive bladder cancer is a demanding surgical procedure usually followed by a variable period of inability. It might be even more delicate in the elderly. We describe our protocol of pre, intra, and post operative management aimed at minimising the impact of bladder cancer surgery.
  
  
  METHODS
  The patients were submitted to reduced pre-operative fasting (6-8 hours), no mechanical bowel preparation, and insertion of an epidural cannula. Intra-operative Intra-operatively the protocol included: combined anesthesia (general+epidural), controlled hypotension, correction of blood losses in excess of 10% of the estimated total blood volume, O2 supplementation and insertion of a je, junal cannula for nutrition. Post-operatively: early removal of naso-gastric tubing (2-6 hours), parenteral and enteral nutrition started ion POD1.
  
  
  RESULTS
  The feasibility study was conducted on 18 patients, 14 males and 4 women, median age 70 years (range 55 to 82). Six patients belonged to category ASA II, and 12 to ASA III-IV. The protocol was completed by 10 patients and no completed by 8. The only step of the protocol that was not completed was the enteral nutrition that caused symptoms of bowel distension. Among the patients who completed the protocol the return of peristalsis and of normal bowel function were observed on POD 1, and POD 2, respectively, whereas, the recovery required one day more in the remaining patients.
  
  
  CONCLUSIONS
  The protocol was feasible, and contributed to an accelerated recovery of intestinal function. Compliance to the protocol was independent from age. The study is ongoing for a more precise evaluation of the outcomes of the protocol.
authors.affiliation: Department of Urology, E. O. Ospedali Galliera, Mura delle Cappuccine 14, Genova 16128, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Maffezzini
authors.forename: Guido
authors.initials: G
authors.lastname: Gerbi
authors.forename: Fabio
authors.initials: F
authors.lastname: Campodonico
authors.forename: Donatella
authors.initials: D
authors.lastname: Parodi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Capponi
authors.forename: Antonio
authors.initials: A
authors.lastname: Spina
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Guerrieri
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D015653:Cystectomy; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D019990:Perioperative Care / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion