Rawal Sudhir, Khanna Samir, Kaul Rakesh, Goel Ashish, Puri Anoop, Singh Mandeep
Department of Genito-Uro Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India.
Indian J Urol. 2012 Apr;28(2):189-92. doi: 10.4103/0970-1591.98463.
This retrospective study evaluates the morbidity and outcome of cystectomy and urinary diversion in octogenarians with invasive bladder cancer. Records of all patients older than 80 years who underwent cystectomy during the last 10 years were analyzed retrospectively. Among 565 cystectomies, 11(< 2%) patients were identified and evaluated for intraoperative and postoperative complications and mortality post surgery. The median age was 82 years. One female and ten male patients were selected. Eight patients were hypertensive, three were diabetic, one had coronary artery disease, two had chronic lung disease and one had depression. Seven patients presented with hematuria, two had lower urinary tract symptoms and two presented with renal failure who were optimized for renal function. All patients had ileal conduit as the form of urinary diversion. Simultaneous urethrectomy was done in two patients. Median surgical time was 5 h. Median hospital stay after surgery was 10 days. Four patients had pneumonitis and one patient developed hemiplegia, but all patients were eventually discharged. One patient expired due to stent septicemia within one month after discharge. Follow-up ranged from four months to five years. Three patients expired three years after surgery-one due to disease recurrence and the other two due to unrelated cause. One patient was lost to follow-up and six patients are doing well. Our results support the use of cystectomy in octogenarians with invasive bladder cancer, which has acceptable morbidity and mortality, and offers the best chance for sustained disease-free quality survival.
这项回顾性研究评估了患有浸润性膀胱癌的八旬老人行膀胱切除术及尿流改道的发病率和预后情况。对过去10年中所有年龄超过80岁且接受膀胱切除术的患者记录进行了回顾性分析。在565例膀胱切除术中，确定并评估了11例（<2%）患者的术中及术后并发症和术后死亡率。中位年龄为82岁。入选了1例女性和10例男性患者。8例患者患有高血压，3例患有糖尿病，1例患有冠状动脉疾病，2例患有慢性肺部疾病，1例患有抑郁症。7例患者出现血尿，2例有下尿路症状，2例出现肾功能衰竭，对其肾功能进行了优化。所有患者均采用回肠膀胱术作为尿流改道方式。2例患者同时进行了尿道切除术。中位手术时间为5小时。术后中位住院时间为10天。4例患者发生肺炎，1例患者发生偏瘫，但所有患者最终均出院。1例患者出院后1个月内死于支架败血症。随访时间为4个月至5年。3例患者术后3年死亡，1例死于疾病复发，另外2例死于无关原因。1例患者失访，6例患者情况良好。我们的结果支持对患有浸润性膀胱癌的八旬老人行膀胱切除术，该手术具有可接受的发病率和死亡率，并为持续无病的高质量生存提供了最佳机会。
