Hi, Marci,
Your friend needs to get a second opinion from a cancer center of excellence...most of these are connected to major academic centers. Where do you live? Although there are some urosurgeons who let age disqualify someone from radical cystectomy(RC) surgery, there are plenty that go by the health of the individual not the age. My urosurgeon performed a radical cystectomy with a neobladder urinary diversion in a woman that was 85 years old at the time, and last I heard she was doing beautifully with a neobladder that was functioning as intended. Neobladders are the type of diversion that is an internal pouch that connects to the urethra so voiding does not require catherization. Many surgeons are hesitant to give neobladders to women and/or the elderly, yet, here is this 85 year old patient of my urosurgeon that is doing great with her neobladder and with a good prognosis for the future .
The lymph/vascular invasion is a worry, but to me it means that he should have an extended lymph node dissection so that as many local and regional lymph nodes as possible are removed just in case cells have escaped the bladder through the lymph/vascular system. USC Norris urosurgeons remove as many as 65+ lymph nodes whereas most centers remove between 10-20. My surgeon removed 7 from each side for a total of 14 and I wish he had removed many more just to be on the safe side. USC Norris has the best long-term survival rate compared with other major centers, and I cannot help but think their stand on extensive lymph node removal influences those good results.
Here is an excerpt from a medical journal artical about RC/urinary diversions in the elderly with 52 of the patients in this study 80 years old or older:
"CONCLUSIONS: These data suggest that an aggressive, curative, radical surgical approach and urinary diversion may be a viable treatment strategy for properly selected elderly patients who are in generally good health and require definitive therapy for invasive bladder carcinoma."
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9655304&dopt=Abstract
or
tinyurl.com/nu6pw
Here is another:
"In conclusion, indication of cystectomy and selection of urinary reconstruction procedure are not dependent on patient's age, Orthotopic urinary reservoir [neobladder] was found to be useful for even an elderly patient.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10086261&dopt=Abstract
or
tinyurl.com/pbkfd
And, another:
"Conclusions: Radical cystectomy can be performed in elderly patients with acceptable perioperative mortality and morbidity. However, because of the high incidence of minor medical complications, hospital stay is often prolonged."
content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ProduktNr=224083&Ausgabe=227844&ArtikelNr=52498&filename=52498.pdf
or
tinyurl.com/m3xrw
I could probably find more references if you need them.
By the time you read this, your friend would have had his second opinion. I am sorry I did not read your post earlier so I could have responded earlier. Again, I cannot stress enough just how important it is for him to be seen at an academic cancer center that does many of these type operations. These are the urosurgeons with the knowledge and experience offer your friend with the best treatment path for his survival. Please let me know what the second urologist advised. where you live, and who he saw.
Hope this helps,
Linda W. neobladder 2/2002