Service d'Urologie, Transplantation Rénale et Andrologie, CHU, Toulouse, France.
Urology. 2012 Mar;79(3):585-90. doi: 10.1016/j.urology.2011.11.042.
To compare the perioperative outcomes of laparoscopic/robotic radical cystectomy (LRRC) for urothelial cancer of bladder (UCB) between elderly (≥ 70 years) and younger (<70 years) patients.
A retrospective review of 146 patients who underwent LRRC between 2003 and 2010 at 2 academic institutions (Cleveland, Ohio, United States and Toulouse, France) was performed. Of these, 74 patients were classified as elderly (≥ 70 years) and 72 patients were considered younger (<70 years). Perioperative outcomes, final pathology results, overall survival (OS), and cancer specific survival (CSS) were compared between the 2 groups.
Both groups had similar clinical stage at diagnosis, American Society of Anesthesiologists score, body mass index, and gender distribution. Ileal conduit-type diversion was favored in the older vs younger group, 84% vs 36%, respectively. Overall conversion rate to open procedures was 4% in both groups. Perioperative complication rate was not significantly different between the younger and older patients. Positive margin rate was 5% in both groups. The 5-year OS for older and younger patients was 75% and 87%, respectively (P = .03), and the 5-year CSS for the 2 groups was 51% and 54%, respectively (P = .7).
Laparoscopic/robotic radical cystectomy in the elderly does not have worse perioperative complications or pathologic outcomes compared with younger patients and therefore can be offered as treatment option in select older patients.
比较腹腔镜/机器人根治性膀胱切除术（LRRC）治疗膀胱尿路上皮癌（UCB）在老年（≥70 岁）和年轻（<70 岁）患者中的围手术期结果。
回顾性分析了 2003 年至 2010 年在 2 个学术机构（美国俄亥俄州克利夫兰和法国图卢兹）接受 LRRC 的 146 例患者。其中，74 例患者被归类为老年（≥70 岁），72 例患者被认为是年轻（<70 岁）。比较两组患者的围手术期结果、最终病理结果、总生存期（OS）和癌症特异性生存期（CSS）。
两组患者在诊断时的临床分期、美国麻醉医师协会评分、体重指数和性别分布均相似。老年组与年轻组相比，分别有 84%和 36%的患者采用回肠造口术。两组总体中转开放手术的比例均为 4%。年轻患者和老年患者的围手术期并发症发生率无显著差异。两组患者的切缘阳性率均为 5%。老年和年轻患者的 5 年 OS 分别为 75%和 87%（P=0.03），两组的 5 年 CSS 分别为 51%和 54%（P=0.7）。
与年轻患者相比，老年患者接受腹腔镜/机器人根治性膀胱切除术的围手术期并发症或病理结果并不差，因此可以作为选择老年患者的治疗选择。
