Wuethrich Patrick Y, Vidal Alvaro, Burkhard Fiona C
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland; Department of Urology, Inselspital, Bern University Hospital, University of Bern.
Department of Urology, Inselspital, Bern University Hospital, University of Bern; Medicine faculty, Universidad de Chile, Santiago, Chile and Fundación Arturo López Pérez, Santiago, Chile.
Urol Oncol. 2016 Feb;34(2):58.e19-27. doi: 10.1016/j.urolonc.2015.08.011. Epub 2015 Sep 26.
The incidence of cancer increases with age and owing to the changing demographics we are increasingly confronted with treating bladder cancer in old patients. We report our results in patients>75 years of age who underwent open radical cystectomy (RC) and urinary diversion.
From January 2000 to March 2013, a consecutive series of 224 old patients with complete follow-up who underwent RC and urinary diversion (ileal orthotopic bladder substitute [OBS], ileal conduit [IC], and ureterocutaneostomy [UCST]) were included in this retrospective single-center study. End points were the 90-day complication rates (Clavien-Dindo classification), 90-day mortality rates, overall and cancer-specific survival rates, and continence rates (OBS).
Median age was 79.2 years (range: 75.1-91.6); 35 of the 224 patients (17%) received an OBS, 178 of the 224 patients (78%) an IC, and 11 of the 224 patients (5%) an UCST. The 90-day complication rate was 54.3% in the OBS (major: Clavien grade 3-5: 22.9%, minor: Clavien Grade 1-2: 31.4%), 56.7% in the IC (major: 27%, minor: 29.8%), and 63.6% in the UCST group (major: 36.4%, minor: 27.3%); P = 0.001. The 90-day mortality was 0% in the OBS group, 13% in the IC group, and 10% in the UCST group (P = 0.077). The Glasgow prognostic score was an independent predictor of all survival parameters assessed, including 90-day mortality. Median follow-up was 22 months. Overall and cancer-specific survivals were 90 and 98, 47 and 91, and 11 and 12 months for OBS, IC, and UCST, respectively. In OBS patients, daytime continence was considered as dry in 66% and humid in 20% of patients. Nighttime continence was dry in 46% and humid 26% of patients.
With careful patient selection, oncological and functional outcome after RC can be good in old patients. Old age as the sole criterion should not preclude the indication for RC or the option of OBS. In old patients undergoing OBS, satisfactory continence results can be achieved.
癌症发病率随年龄增长而升高，由于人口结构的变化，我们越来越多地面临着治疗老年膀胱癌患者的问题。我们报告了年龄>75岁接受开放性根治性膀胱切除术（RC）及尿流改道患者的治疗结果。
本回顾性单中心研究纳入了2000年1月至2013年3月期间连续的224例接受RC及尿流改道（回肠原位膀胱替代术[OBS]、回肠膀胱术[IC]和输尿管皮肤造口术[UCST]）且有完整随访资料的老年患者。观察终点为90天并发症发生率（Clavien-Dindo分级）、90天死亡率、总生存率和癌症特异性生存率以及控尿率（OBS）。
中位年龄为79.2岁（范围：75.1 - 91.6岁）；224例患者中35例（17%）接受OBS，224例患者中178例（78%）接受IC，224例患者中11例（5%）接受UCST。OBS组90天并发症发生率为54.3%（严重：Clavien 3 - 5级：22.9%，轻微：Clavien 1 - 2级：31.4%），IC组为56.7%（严重：27%，轻微：29.8%），UCST组为63.6%（严重：36.4%，轻微：27.3%）；P = 0.001。OBS组90天死亡率为0%，IC组为13%，UCST组为10%（P = 0.077）。格拉斯哥预后评分是所有评估生存参数的独立预测因素，包括90天死亡率。中位随访时间为22个月。OBS、IC和UCST的总生存率和癌症特异性生存率分别为90和98个月、47和91个月以及11和12个月。在OBS患者中，66%的患者白天控尿情况为干爽，20%为潮湿。46%的患者夜间控尿干爽，26%为潮湿。
通过仔细选择患者，老年患者RC后的肿瘤学和功能结局可以良好。不应仅以年龄作为唯一标准来排除RC的适应症或OBS的选择。对于接受OBS的老年患者，可以取得令人满意的控尿结果。
