Quintens H, Guy L, Mazerolles C, Théodore C, Amsellem D, Roupret M, Wallerand H, Roy C, Saint F, Bernardini S, Lebret T, Soulié M, Pfister C
Service d'urologie, Institut A Tzanck, Avenue du Docteur Dodat, 06700 Nice, France.
Prog Urol. 2009 Nov;19 Suppl 3:S135-41. doi: 10.1016/S1166-7087(09)73360-3.
Total cystectomy is the reference treatment for infiltrating nonmetastatic bladder cancers. With the progress in anesthesia and postoperative intensive care, this treatment can be applied to a population of elderly subjects provided there is a strict oncological and geriatric evaluation of the patient. Recent series reporting total cystectomies in subjects over 75 years of age report comparable morbidity and mortality rates to the general population. Strategies to preserve the vesical reservoir can be indicated in selected cases. Their objectives are to guarantee local control and follow-up identical to radical cystectomy, while preserving a functional bladder and good quality of life. The strategies including transurethral resection with radiochemotherapy are analyzed. Thus, with multidisciplinary consensus and adapted management, elderly patients with significant comorbidities should not be automatically excluded from access to effective treatment of these cancers.
全膀胱切除术是浸润性非转移性膀胱癌的标准治疗方法。随着麻醉和术后重症监护技术的进步，只要对患者进行严格的肿瘤学和老年医学评估，这种治疗方法就可以应用于老年患者群体。最近关于75岁以上患者行全膀胱切除术的系列报道显示，其发病率和死亡率与普通人群相当。在某些特定病例中，可以采用保留膀胱储尿功能的策略。其目的是确保局部控制和随访与根治性膀胱切除术相同，同时保留功能性膀胱并维持良好的生活质量。本文分析了包括经尿道切除联合放化疗在内的各种策略。因此，通过多学科共识和适当的管理，患有严重合并症的老年患者不应被自动排除在这些癌症的有效治疗之外。
