The biggest operation on the oldest patient

Note: Our patient has given permission to use his story and name in our article and we are preparing a press release to give more details of this incredible story.
At 94 years old, the diagnosis of invasive bladder cancer is devastating. The treatment of choice for invasive bladder cancer is a radical cystoprostatectomy- the surgical removal of the bladder and prostate.
At 94 most urologists would tell the patient they are too old for surgery, but with Dr. Lefkon’s help I had performed this operation in a 90 year old woman and 94 year old man before and with Dr. Katz’s help had performed the operation in a 92 year old woman and a 96 year old woman.


When Dr. Katz’s diagnosed a recent patient with muscle invasive bladder cancer he recommended the removal of the bladder and prostate. To my partners surprise, the first question from the patient after understanding the implication of this life threatening surgery was:
How long will I be out of work?
It seems that at 94 he is not retired, but is in the process of marketing a lotion he designed. He has developed a lotion that is called Kling, a moisturizing and deodorizing lotion. He spent the last 2 years finishing the product and it is now ready for sale.
I was then asked about performing a robotic operation to try to speed up his recovery.
On Monday, Jan 9, 2006, in a little less than 4 hours and after loosing less blood than a person would loose from a transfusion, he was awakened in the operating room and spent the first night on a regular surgical floor, without an ICU stay.
He recovered over the next few days and was drinking by Wednesday and walking by Wednesday. His pain was minimal enough by Friday to stop taking pain medicine and he was discharged to home on Sunday, without needing an rehab stay.
At 94 years old, or 60 years older than I am, he still has risk until he is fully recovered, but his robotic surgery and hospital stay went as well as it possibly could have. I believe that he is the oldest person to ever undergo robotic surgery and probably one of less than 200 people to have this type of operation done robotically. Most robotic urologists don’t have the cancer training and open surgical experience to perform this kind of operation.
This blog entry brings up several points including:
Heroic measures as patients get older. What patients are too old for what type of care. In any other country I do not believe he would have received this operation.
The use of an expensive technology- what kind of benefits really exist?
One of the criticisms of robotic surgery is that it costs more and is unnecessary. In properly trained hands, this story shows what kind of benefits can be achieved. My previous four nonagenarians all spent 9-14 days in the hospital and all needed rehab stays of about 2 weeks prior to going home.
Human interest story- Without the cancer, this gentleman is a story by himself. At 94 he is starting a business.

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