Fontana Pamela Portella, Gregorio Sergio Alonso Y, Rivas Juan Gómez, Sánchez Leslie Cuello, Ledo Jesús Cisneros, Gómez Ángel Tabernero, Sebastián Jesús Díez, Barthel Jesús Javier de la Peña
Department of Urology, Hospital Universitario La Paz, Madrid, Spain.
Department of Biostatistics, Hospital Universitario La Paz, Madrid, Spain.
Cent European J Urol. 2015;68(1):24-9. doi: 10.5173/ceju.2015.01.498. Epub 2015 Mar 13.
Radical cystectomy in elderly patients is a controversial issue that has noticed an increase in importance overtime because of the lengthening average life span. Our objective was to determine if there were significant differences in the perioperative outcomes of patients over 70 years with bladder cancer treated with laparoscopic radical cystectomy (LRC) compared to those of younger patients.
We selected 180 patients who underwent LRC in our department in the period between 2005-2012. We divided them into 2 groups: 57% <70 years and 43% >70 years, and we compared the different parameters such as: comorbidities, intraoperative and post-operative complications, TNM stage and overall survival.
The group <70 years had less comorbidities when compared with the group >70 years. Heterotopic urinary diversion was the diversion of choice in the elderly patients (97.4%). Paralytic ileus and the worsening of renal function were the only complications with statistical differences between the groups. Mean hospital length of stay was not significantly different between the groups. Younger and older patients had similar pathological staging : pT1 or less: 26,2 vs. 18.2%, pT2: 19.4 vs. 16.9%, pT3 38.8 vs. 37.7% and pT4 15.6 vs. 17.2%. Kaplan-Meier curves did not show significant differences in survival.
Laparoscopic radical cystectomy in the elderly patient has similar rates of perioperative morbidity when compared with the younger patient and may be offered as a treatment option in selected elderly patients.
老年患者的根治性膀胱切除术是一个存在争议的问题，随着平均寿命的延长，其重要性与日俱增。我们的目的是确定与年轻患者相比，70岁以上膀胱癌患者接受腹腔镜根治性膀胱切除术（LRC）的围手术期结果是否存在显著差异。
我们选择了2005年至2012年期间在我科接受LRC的180例患者。我们将他们分为两组：57%年龄<70岁，43%年龄>70岁，并比较了不同参数，如：合并症、术中及术后并发症、TNM分期和总生存率。
与年龄>70岁的组相比，年龄<70岁的组合并症较少。异位尿流改道是老年患者的首选改道方式（97.4%）。麻痹性肠梗阻和肾功能恶化是两组间唯一有统计学差异的并发症。两组的平均住院时间无显著差异。年轻和老年患者的病理分期相似：pT1或更低：26.2%对18.2%，pT2：19.4%对16.9%，pT3：38.8%对37.7%，pT4：15.6%对17.2%。Kaplan-Meier曲线显示生存率无显著差异。
与年轻患者相比，老年患者的腹腔镜根治性膀胱切除术围手术期发病率相似，在选定的老年患者中可作为一种治疗选择。
