Elderly bladder cancer patients with co-existing illnesses are at high risk for complications following radical cystectomy (RC). When it comes to choosing a urinary diversion, cutaneous ureterostomy (CU) with a single stoma deserves consideration along with ileal conduit (IC), Italian researchers suggest.
Nicola Longo, MD, of the University Federico II of Naples in Italy, and colleagues reviewed the medical records of 70 patients older than 75 years who underwent RC during 2009–2014. RC was performed by a single surgeon using a standard intraperitoneal approach with pelvic lymph node dissection. Half of patients received CU with a single stoma and half received IC (using Bricker’s technique), according to the surgeon’s preference. Those with a history of pelvic surgery, radiotherapy, and neoadjuvant chemotherapy—factors known to increase complications—were excluded. The average follow-up was 3.5 years.
At baseline, the 2 groups were similar with respect to age, gender, American Society of Anesthesiologists score, type of indication, pathologic features, and comorbidities. Muscle-invasive bladder cancer was diagnosed in 94.2% of IC and 97.1% of CU patients, respectively. Cardiovascular disorders were found in 71.4% and 77.1% of patients, respectively, and chronic obstructive pulmonary disease was found in 42.8% and 51.4%, respectively. Other comorbidities included diabetes, chronic kidney disease, ulcer disease, and liver disease.
Results showed that operating time, blood loss, need for intensive care, time to drainage removal, and duration of hospital stay were significantly higher in patients having IC. Complications during and after RC were also significantly higher among IC patients, such as prolonged ileus, urinary leakage, and fever.
Patients reported no negative impact of CU on quality of life compared with IC. The investigators used the Bladder Cancer Index, which gauges urinary, bowel, and sexual function as well as bother.
According to the investigators, their study is in line with a study published in Urology (2005;66:299-304) demonstrating that reported lower operative times, intra-operative complications, need for intensive care, and length of hospital stay, for CU patients. Comparison with other studies proved difficult due to differences in patient populations.
“Considering that CU is the easier and quicker urinary diversion, this option should be strongly considered and discussed when an elderly patient with relevant comorbidities is being considered for RC from an oncological point-of-view,” Dr Longo and colleagues wrote in BJU International.
Among the limitations, the researchers noted that long-term complications such as those related to stents, were not assessed.