Quality of life and overall survival in high risk patients after radical cystectomy with a simple urinary derivation

OBJECTIVE: To evaluate quality of life (QoL) and overall survival after radical cystectomy with cutaneous ureterostomies for advanced bladder cancer in elderly patients with high surgical risk. METHODS: 58 patients, over74 years of age (mean age 80,6±4,3) with locally advanced bladder cancer (group A), underwent radical cystectomy and ureterocutaneous diversion. Patients completed the EORTC QLQC30 before and six months after surgery to assess functional, clinical and QoL outcomes. The same evaluation was carried out in a control group (group B) of 29 patients (mean age 82,3±3,8 years), who had refused cystectomy. Questionnaires were also administered to patients of both groups who survived at 20 months and 5 years. RESULTS: All patients presented an ASA score ≥3. Mean hospital stay was 15.1 days (±4.8) in group A and 23.5 days (±4.1) in Group B for frequent hospitalizations. No intraoperative complications occurred in group A. Postoperative morbidity were defined and classified according to the Clavien score system. Postoperative overall survival evaluated within 6 months in group A was 97% versus 79% in group B (p<0.001). Relation between two groups at 6 months for Qol, functional and symptomatic items investigated showed in group A a statistically significant improvement for all parameters (p<0,001). This advantage for patients belonging to group A still resulted evident at 20 months and 5 years. Short-term and 20 months overall survival resulted statistically significant in favour of group A (p<0.001). CONCLUSION: Radical cystectomy with cutaneous ureterostomy represents a valid alternative in elderly patients with invasive bladder cancer and high operative risk. Comparison between two groups showed a statistically significant difference for almost all the Qol related parameters and for short and medium term overall survival.