Cusano Antonio, Haddock Peter, Staff Ilene, Jackson Max, Abarzua-Cabezas Fernando, Dorin Ryan, Meraney Anoop, Wagner Joseph, Shichman Steven, Kesler Stuart
Hartford Healthcare Medical Group, Hartford, Connecticut, USA.
Can J Urol. 2015 Feb;22(1):7607-13.
Urologic malignancies are often diagnosed at an older age, and are increasingly managed utilizing robotic-assisted surgical techniques. As such, we assessed and compared peri-postoperative complication rates following robotic urologic surgery in elderly and younger patients.
A retrospective analysis of IRB-approved databases and electronic medical records identified patients who underwent robotic-assisted urologic surgery between December 2003-September 2013. Patients were grouped according to surgical procedure (partial nephrectomy, radical cystectomy, radical prostatectomy) and age at surgery (≤ 74 or ≥ 75 years old). Associations between age, comorbidities, Charlson comorbidity index (CCI), and patient outcomes were evaluated within each surgery type.
97.5% and 2.5% of patients were ≤ 74 or ≥ 75 years old, respectively. Cystectomies, partial nephrectomies and prostatectomies accounted for 3.5%, 9.5% and 87.1% of surgeries, respectively. Within cystectomy, nephrectomy and prostatectomy groups, 24.4%, 12.5% and 0.6% patients were ≥ 75 years old. Within each surgical type, elderly patients had significantly elevated CCI scores. Length of stay was significantly prolonged in elderly patients undergoing partial nephrectomy or prostatectomy. In elderly cystectomy, partial nephrectomy and prostatectomy patients, 36.7%, 14.3% and 5.9% suffered ≥ 1 Clavien grade 3-5 complication, respectively. Major complications were not significantly different between age groups. A qualitatively similar pattern was observed regarding Clavien grade 1-2 complications.
The risks of robotic-assisted urologic surgery in elderly patients are not significantly elevated compared to younger patients.
泌尿系统恶性肿瘤通常在老年时被诊断出来，并且越来越多地采用机器人辅助手术技术进行治疗。因此，我们评估并比较了老年患者和年轻患者在机器人辅助泌尿外科手术后的围手术期并发症发生率。
对经机构审查委员会（IRB）批准的数据库和电子病历进行回顾性分析，确定了2003年12月至2013年9月期间接受机器人辅助泌尿外科手术的患者。患者根据手术方式（部分肾切除术、根治性膀胱切除术、根治性前列腺切除术）和手术时的年龄（≤74岁或≥75岁）进行分组。在每种手术类型中评估年龄、合并症、Charlson合并症指数（CCI）与患者预后之间的关联。
分别有97.5%和2.5%的患者年龄≤74岁或≥75岁。膀胱切除术、部分肾切除术和前列腺切除术分别占手术的3.5%、9.5%和87.1%。在膀胱切除术、肾切除术和前列腺切除术组中，≥75岁的患者分别占24.4%、12.5%和0.6%。在每种手术类型中，老年患者的CCI评分显著升高。接受部分肾切除术或前列腺切除术的老年患者住院时间显著延长。在老年膀胱切除术、部分肾切除术和前列腺切除术患者中，分别有36.7%、14.3%和5.9%发生≥1例Clavien 3 - 5级并发症。各年龄组之间的主要并发症无显著差异。关于Clavien 1 - 2级并发症也观察到了定性相似的模式。
与年轻患者相比，老年患者进行机器人辅助泌尿外科手术的风险没有显著升高。
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