OBJECTIVE: Radical cystectomy is the standard treatment for invasive bladder carcinoma in elderly patients at major surgical centers. As yet no data are available as to the question whether radical surgery on the genitourinary tract of patients over 75 can also be carried out at municipal hospitals with comparable intra and postoperative morbidity, and respective mortality. MATERIALS AND METHODS: 452 radical cystectomies and urinary diversions as ileum conduits or ileum neobladders due to transitional cell carcinoma were carried out at three municipal hospitals between 1992 and 2004. At the time of the surgery, 44 patients (9.7%) were > 75 (75-84) (Group-1), by comparison 408 patients were younger than 75 (35-74) (Group-2). Comparisons are to be made between the groups for 30 day mortality, 30 day reoperation rate, early complication rate (< 3 months), late complication rate (> 3 months), progression-free survival, and overall survival. The results are to be discussed in view of the international literature. Mean follow-up was 49 months (median: 38 months). RESULTS: The perioperative mortality in Group-1 was 2.3% compared to 2.5% in Group-2 (p = 0.942). There was no significant difference in the perioperative mortality with regard to the different case load of the evaluated hospital. There were no significant group differences regarding the 30 day reoperation rate, early and late complications. Progression-free and overall survival of all patients after 5 years was 56.1% and 53.6% respectively; here again the differences between the age groups was not significant (p = 0.384 and p = 0.210). Our results for patients > 75 do not differ from the published data of large clinics with a high cystectomy frequency. CONCLUSIONS: Our data confirm that radical cystectomy on elderly patients can also be carried out in municipal hospitals with acceptable mortality and morbidity rates. Of prime importance is a careful patient selection based on comorbidity scores and possibly geriatric assessment.

Objectives: Experimental data show the relationship between the area of injured urothelium and recurrence rates in superficial bladder cancer. Tumor cell adherence is increased by the exposure to the extracellular matrix (ECM). Transurethral resection uncovers the ECM and might lead to recurrent tumors. The question ifrecurrences are increased by enlarged urothelium resection areas is difficult to answer because there will be noprospective studies available. We investigated if deeper and larger urothelial injuries, which are caused by differentiated resections lead to higher recurrence and progression rates than regular resections of bladdertumors. Methods:163 patients with superficial bladder cancer were retrospectively evaluated. Sixty-six received a differentiated resection and 97 a regular one. We analyzed the recurrence and progression rates over a minimum of 48 months as well as tumor persistence in the second resection. Results: Patients with differentiated resections of bladder tumors were found to have no higher incidence of tumor recurrence and progression but showed a significantly higher percentage of tumor free second resections. Conclusions: As a model of enlarged urotheliallesions the differentiated resection technique for superficial bladder cancer has no negative influence on recurrence or progression rates. It seems unlikely that the extracellular matrix uncovered by resection is the main reason for the high recurrence rates. The significantly lower incidence of tumor persistence in the second resection favors the differentiated resection technique in the transurethral treatment.

Objetivo: Los datos experimentales muestran correlación entre el área de urotelio dañado y la tasa de recurrencia en cáncer superficial de la vejiga. La adherencia de las células tumorales aumenta frente a la exposición da la matriz extracelular (ECM). La resección transuretral de los tumores vesicales (TURB) descubre el ECM y puede favorecer la recurrencia. La pregunta si la recurrencia aumenta en los casos de grandes áreas de resección es difícil de contestar, porque nunca habrá estudios prospectivos al respecto. En este estudio investigamos si lesiones del urotelio más profundas y más grandes, como las que son causadas por resecciones "diferenciadas" se relacionan con mayores tasas de recurrencia y progresión que resecciones regulares de los tumores vesicales. Métodos: 163 pacientes con cáncer vesical superficial fueron evaluados retrospectivamente. 66 fueron tratados con una TURB "diferenciada" y 97 con una TURB regular. Analizamos las tasas de recurrencia y progresión en un seguimiento mínimo de 48 meses, así como la persistencia de tumor en la re-resección. Resultados: Los pacientes sometidos a TURB "diferenciada" mostraron no tener ninguna incidencia más alta de recurrencia y/o de progresión del tumor, pero mostraron un porcentaje significativamente más alto de resecciones libres de tumor en la re-resección. Conclusiones: Como modelo de lesión urotelial mayor, la técnica de TURB "diferenciada" para cáncer superficial de vejiga no muestra ninguna influencia negativa en las tasas de recurrencia y progresión. Parece improbable que la matriz extracelular descubierta por la resección transuretral sea la razón principal de las altas tasas de recurrencia. Por otro lado, la significativa menor incidencia de persistencia tumoral en la segunda resección favorece a la técnica "diferenciada" de resección en el tratamiento transurethral de los tumores vesicales superficiales.