79 M with recent TURBT demonstrating invasive bladder cancer.
Background
- Invasive bladder and prostate cancer (Gleeson 7)
- CABG – nil ongoing symptoms
- AF – apixaban
- Mild COPD and restrictive defect secondary to central obesity – NYHA III
- Stage 3 CKD
- OSA – moderate/obstructive – not treated
- BMI 34, central
Issues
- Perioperative risks
- Risk assessment: NSQIP – 50% chance of serious complications, 6% risk of death, 60% risk of discharge to ‘other than home’, 12% delirium
- ? patient’s ability to manage and cutaneous urinary stoma – currently needs assistance with shopping/cleaning
- Patient values current independence
- ? Further Ix warranted for SOBOE
- SOBOE – previously reviewed by Respiratory physician – likely deconditioned rather than a treatable cause
- TTE – nil significant findings (recent medical admission for urosepsis, long lie and myocardial injury – trop 200)
- Other non-surgical options?
- Patient has yet to meet with surgical team to discuss diagnosis and treatment options
Discussion
- High risk procedure
- Surgical pathway seems likely to lead to loss of independence/function sooner than a non-surgical pathway
- Patient does not seem likely to engage meaningfully with prehab
- CPET unlikely to present any information not already known (high periop risk ++)
Plan
- Discussion with surgeons – alternative options (?RTx) due to periop risks
- No CPET
- Refer to GP for assessment of early cognitive impairment
Perioperative Talk 