1 Department of Urology, Boston Medical Center , Boston, Massachusetts.
J Endourol. 2014 Feb;28(2):219-23. doi: 10.1089/end.2013.0159. Epub 2013 Dec 26.
Radical cystectomy is the standard of care for muscle-invasive bladder cancer; however, few patients over age 75 undergo cystectomy. Morbidity and mortality rates in this age group approach 60% and 10%, respectively. We sought to determine if minimally invasive surgery, in the form of robot-assisted radical cystectomy (RARC), may reduce morbidity and mortality associated with this operation in elderly patients.
After Institutional Review Board approval, all RARC performed between 2009 and 2012 from one institution were reviewed, and 23 cases in patients over the age of 80 were identified. Data analyzed included age, indication for cystectomy, American Society of Anesthesiologists score (ASA), Charlson Comorbidity Index, pathologic stage, estimated blood loss, transfusion rate, and 90-day morbidity and mortality rate.
Twenty-three patients over the age of 80 years underwent RARC by a single surgeon (IT) between April 2009 and October 2012. Average age was 83.7 years (range 80-88 years) with average Charlson Comorbidity Index score of 4.3 (age-weighted 8.3). Indication for cystectomy was oncologic in all cases (21 bladder malignancy, 2 hemorrhagic cystitis in the setting of prostate cancer). The average blood loss and operative times were 208 mL (range 50-650 mL) and 253 minutes (range 175-365 min). Seven (30.4%) patients needed blood transfusions. The average length of hospital stay was 8.2 days (range 6-24 days). The overall complication rate within 90 days was 34.8% (8 patients) with no mortality. Longest follow-up is 34 months.
RARC should be strongly considered for patients over the age of 80 with clinical indications for cystectomy. The complication rate is acceptable even in complicated patients with multiple comorbidities and those with previous abdominal surgery or pelvic radiation. Hospital stay remains shorter than with open surgery, and complication rates appear to be lower than previously reported for this age group.
根治性膀胱切除术是肌层浸润性膀胱癌的标准治疗方法；然而，只有少数 75 岁以上的患者接受了膀胱切除术。该年龄段的发病率和死亡率分别接近 60%和 10%。我们试图确定微创外科（机器人辅助根治性膀胱切除术[RARC]）是否可以降低老年患者接受该手术的发病率和死亡率。
在获得机构审查委员会批准后，回顾了 2009 年至 2012 年期间在一家机构进行的所有 RARC，并确定了 23 例年龄在 80 岁以上的患者。分析的数据包括年龄、膀胱切除术的适应证、美国麻醉医师协会评分（ASA）、Charlson 合并症指数、病理分期、估计失血量、输血率以及 90 天发病率和死亡率。
2009 年 4 月至 2012 年 10 月期间，一位外科医生（IT）为 23 名 80 岁以上的患者进行了 RARC。平均年龄为 83.7 岁（80-88 岁），平均 Charlson 合并症指数评分为 4.3（年龄加权 8.3）。所有病例均为肿瘤性膀胱切除术（21 例膀胱癌，2 例前列腺癌合并出血性膀胱炎）。平均失血量和手术时间分别为 208ml（50-650ml）和 253 分钟（175-365min）。有 7 名（30.4%）患者需要输血。平均住院时间为 8.2 天（6-24 天）。90 天内总体并发症发生率为 34.8%（8 例），无死亡。最长随访时间为 34 个月。
对于有临床膀胱切除术适应证的 80 岁以上患者，应强烈考虑行 RARC。即使在合并多种合并症的复杂患者以及有既往腹部手术或盆腔放疗史的患者中，其并发症发生率也可接受。与开放性手术相比，住院时间仍然较短，且并发症发生率似乎低于该年龄段的先前报道。
