Berneking Adam D, Rosevear Henry M, Askeland Eric J, Newton Mark R, O'Donnell Michael A, Brown James A
University of Iowa, Iowa City, IA 52242-1089, USA.
Can J Urol. 2013 Aug;20(4):6826-31.
Recent evidence suggests that radical cystectomy may be underutilized in elderly patients, despite literature supporting acceptable morbidity/mortality in this population. However, there is a paucity of literature reporting complications in a standardized manner. Therefore, we evaluated the morbidity and mortality of octogenarians treated with radical cystectomy using the modified Clavien complication reporting system.
We retrospectively reviewed 443 consecutive patients undergoing radical cystectomy at our institution between January 2000 and April 2010. Patients who underwent cystectomy for benign conditions were excluded, leaving 359 for analysis. Baseline demographic and perioperative data were reviewed and all complications were graded. We compared the outcomes of our octogenarian population (n = 43) against our younger population (n = 316).
There was no difference between octogenarians and the younger cohort for overall complication rates (86% versus 83%, p = 0.91), or major (33% versus 30%, p = 0.93) or minor (81% versus 80%, p = 0.91) complications. The younger group was more likely to encounter a late complication (41.5% versus 23.3%, p = 0.03). Those 80 years and older trended toward more intraoperative complications (21% versus 10%, p = 0.07). The older group also had a greater propensity for neurological complications (26% versus 11%, p = 0.02), but there was no difference in CVA (2% versus 3%, p = 0.22). There was no difference in mortality rates between the older and younger cohort (2.3% versus 0.9%, p = 0.95).
Radical cystectomy is a morbid procedure regardless of patient age. Age alone should not preclude radical cystectomy in the elderly.
近期证据表明，尽管有文献支持老年患者行根治性膀胱切除术的发病率/死亡率可接受，但该手术在老年患者中的应用可能不足。然而，缺乏以标准化方式报告并发症的文献。因此，我们使用改良的Clavien并发症报告系统评估了接受根治性膀胱切除术的八旬老人的发病率和死亡率。
我们回顾性分析了2000年1月至2010年4月间在我院连续接受根治性膀胱切除术的443例患者。排除因良性疾病行膀胱切除术的患者，剩余359例进行分析。回顾基线人口统计学和围手术期数据，并对所有并发症进行分级。我们将八旬老人组（n = 43）与年轻组（n = 316）的结果进行了比较。
八旬老人组与年轻组在总体并发症发生率（86%对83%，p = 0.91）、严重并发症（33%对30%，p = 0.93）或轻微并发症（81%对80%，p = 0.91）方面无差异。年轻组更易发生晚期并发症（41.5%对23.3%，p = 0.03）。80岁及以上患者术中并发症有增加趋势（21%对10%，p = 0.07）。老年组神经并发症发生率也更高（26%对11%，p = 0.02），但脑血管意外发生率无差异（2%对3%，p = 0.22）。老年组与年轻组的死亡率无差异（2.3%对0.9%，p = 0.95）。
无论患者年龄如何，根治性膀胱切除术都是一种有创伤的手术。仅年龄因素不应排除老年患者行根治性膀胱切除术。
