De Groote Ruben, Gandaglia Giorgio, Geurts Nicolas, Goossens Marijn, Pauwels Elisabeth, D'Hondt Frederiek, Gratzke Christian, Fossati Nicola, De Naeyer Geert, Schatteman Peter, Carpentier Paul, Novara Giacomo, Mottrie Alexandre
1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .
2 O.L.V. Vattikuti Robotic Surgery Institute , Melle, Belgium .
J Endourol. 2016 Jul;30(7):792-8. doi: 10.1089/end.2016.0050. Epub 2016 Jun 6.
To evaluate perioperative morbidity and mortality rate, a 3-year recurrence-free survival, and cancer-specific mortality rate in patients older than 80 years undergoing robot-assisted radical cystectomy (RARC).
We retrospectively collected data of 155 consecutive patients who received RARC for muscle-invasive or high-risk nonmuscle-invasive urothelial carcinoma of the bladder between 2003 and 2014 at a high-volume robotic center. Diversion was performed intra- or extracorporeally according to the surgeon's preferences. Complications were graded according to the Clavien-Dindo system. Logistic regression analyses were used to assess the impact of age on postoperative outcomes.
Of 155 consecutive patients, 22 (14.2%) patients were 80 years or older. Octogenarians did not significantly differ from younger patients in ASA score (p = 0.4) and Charlson comorbidity index (p = 0.4). Prevalence of any grade and high-grade complications was similar in both groups (all p ≥ 0.6). Older patients had a significantly higher pathologic tumor grade (p = 0.04) and a lower use of pelvic lymphadenectomy (p < 0.001). No perioperative mortality rate was recorded within 90 days from surgery. Elderly patients had a similar risk of 3-year oncologic recurrence after surgery compared with their younger counterparts (odds ratio [OR] 1.63; p = 0.2). Conversely, the risk of cancer-specific mortality rate was significantly higher (OR 2.78; p = 0.02).
Patients 80 years or older undergoing RARC for bladder cancer did not have a higher risk of peri- and postoperative morbidity and mortality rate and had a similar 3-year recurrence-free survival, suggesting that RARC can be safely performed in selected elderly patients by experienced surgeons.
评估年龄大于80岁的患者接受机器人辅助根治性膀胱切除术（RARC）后的围手术期发病率和死亡率、3年无复发生存率以及癌症特异性死亡率。
我们回顾性收集了2003年至2014年期间在一家大型机器人手术中心连续接受RARC治疗肌肉浸润性或高危非肌肉浸润性膀胱尿路上皮癌的155例患者的数据。根据外科医生的偏好进行体内或体外尿流改道。并发症根据Clavien-Dindo系统分级。采用逻辑回归分析评估年龄对术后结果的影响。
在155例连续患者中，22例（14.2%）患者年龄在80岁及以上。八旬老人与年轻患者在ASA评分（p = 0.4）和Charlson合并症指数（p = 0.4）方面无显著差异。两组中任何级别和高级别并发症的发生率相似（所有p≥0.6）。老年患者病理肿瘤分级显著更高（p = 0.04），盆腔淋巴结清扫术的使用率更低（p < 0.001）。术后90天内未记录到围手术期死亡率。老年患者术后3年肿瘤复发风险与年轻患者相似（优势比[OR] 1.63；p = 0.2）。相反，癌症特异性死亡率风险显著更高（OR 2.78；p = 0.02）。
80岁及以上的膀胱癌患者接受RARC治疗后围手术期和术后发病率及死亡率风险并不更高，且3年无复发生存率相似，这表明经验丰富的外科医生可以在选定的老年患者中安全地进行RARC。
