Young Matthew J, Elmussareh Muhammad, Weston Philip, Dooldeniya Mohantha
Department of Urology, Pinderfields General Hospital, Mid-Yorkshire Hospitals Trust, Wakefield, West Yorkshire, UK.
Arab J Urol. 2017 Oct 5;15(4):360-365. doi: 10.1016/j.aju.2017.09.002. eCollection 2017 Dec.
To determine if significant differences exist in the perioperative outcomes of patients aged >75 years treated with radical cystectomy (RC) compared to younger patients, as RC is frequently not offered to 'elderly' patients with bladder cancer because of supposed increased risks of complications.
We retrospectively analysed prospectively collected data of all patients that underwent RC in our centre from May 2013 to June 2015. In all, 81 consecutive RCs were identified and included in our study. Patients were divided into two age groups: Group A, aged <75 years (51 patients) and Group B, aged ≥75 years (30). Co-morbidities and perioperative outcomes were compared between the groups. Fisher's exact test was used for statistical analysis.
In 68 patients RC was performed laparoscopically and the remaining 13 patients underwent open RC. The mean (range) age was 70.7 (36-85) years. There were 37 patients with muscle-invasive disease and 42 had non-muscle-invasive disease. The median hospital stay was not significantly different between the two age groups (10 vs 11 days). There was no significant difference in the preoperative Charlson co-morbidity index. The 30-day mortality rate was 4% for those aged <75 years and 6.6% for those aged ≥75 years, with overall perioperative complication rates of 57% vs 66%, respectively. Most complications were minor (Clavien-Dindo Grade I-II) and there was no statistically significant difference between the two cohorts. There was also no statistically significant difference in blood transfusion rates.
RC in patients aged ≥75 years has similar perioperative morbidity when compared with younger patients and can be offered in selected elderly patients. Thus, age should not be an absolute contraindication for RC.
确定与年轻患者相比，接受根治性膀胱切除术（RC）的75岁以上患者围手术期结局是否存在显著差异，因为由于并发症风险增加，膀胱癌“老年”患者通常不接受RC治疗。
我们回顾性分析了2013年5月至2015年6月在本中心接受RC治疗的所有患者的前瞻性收集数据。共识别出81例连续的RC患者并纳入本研究。患者分为两个年龄组：A组，年龄<75岁（51例患者）和B组，年龄≥75岁（30例）。比较两组的合并症和围手术期结局。采用Fisher精确检验进行统计分析。
68例患者接受了腹腔镜RC，其余13例患者接受了开放性RC。平均（范围）年龄为70.7（36 - 85）岁。37例患者患有肌层浸润性疾病，42例患有非肌层浸润性疾病。两个年龄组的中位住院时间无显著差异（10天对11天）。术前Charlson合并症指数无显著差异。75岁以下患者的30天死亡率为4%，75岁及以上患者为6.6%，总体围手术期并发症发生率分别为57%和66%。大多数并发症为轻度（Clavien-Dindo I-II级），两组之间无统计学显著差异。输血率也无统计学显著差异。
与年轻患者相比，75岁及以上患者的RC围手术期发病率相似，可在选定的老年患者中进行。因此，年龄不应成为RC的绝对禁忌证。
