Martin Christopher, West Jeremy M, Palermo Salvatore, Patel Darshan P, Presson Angela P, Comploj Evi, Pycha Armin, Hancock Joel B, Dechet Christopher B, Trenti Emanuela
Huntsman Cancer Institute and Division of Urology, The University of Utah, Salt Lake City, UT, USA.
Department of Urology, University of Iowa Hospitals & Clinics, University of Iowa, Iowa City, IA, USA.
Urologia. 2019 Nov;86(4):183-188. doi: 10.1177/0391560319864846. Epub 2019 Jul 31.
To evaluate preoperative scoring systems and operative management and their relation to complications in patients older than 75 years undergoing cystectomy at two academic institutions.
In total, 212 patients aged 75-95 years with muscle invasive bladder cancer underwent cystectomy at the University of Utah and Central Hospital of Bolzano, Italy. The rates of Grade 3 Clavien-Dindo complications and above in radical cystectomy patients (n = 199) were compared using Eastern Cooperative Oncology Group Scores and American Society of Anesthesiologists Physical Status Classification. The rates of Grade 3 Clavien-Dindo complications and above were also compared by urinary diversion type. Logistic regression was used to control for source institution.
In total, 199 cases were included in the primary analysis. Neither of the preoperative scoring systems were predictive for identification of radical cystectomy patients with ⩾Grade 3 Clavien-Dindo complications. In secondary analysis (n = 212, including partial cystectomy), none of the urinary diversion types associated with radical cystectomy had a significantly different rate of complications. However, partial cystectomy (n = 13) had a significantly lower rate of complications.
Complication rates among elderly patients undergoing cystectomy for muscle invasive bladder cancer were very high. For patients who are approved for surgery after the history and physical exam, none of our objective metrics adequately predicted operative risk. A unique diversion procedure described by the Bolzano group, uretero-ureterocutaneostomy, had equivalent complication rates to the more common diversion procedures. It also appears based on outcomes in this cohort that partial cystectomy is a particularly favorable option within the elderly population in terms of perioperative morbidity.
评估两家学术机构中75岁以上接受膀胱切除术患者的术前评分系统、手术管理及其与并发症的关系。
共有212例年龄在75 - 95岁之间的肌层浸润性膀胱癌患者在犹他大学和意大利博尔扎诺中心医院接受了膀胱切除术。使用东部肿瘤协作组评分和美国麻醉医师协会身体状况分类法，比较根治性膀胱切除术患者（n = 199）中3级及以上Clavien-Dindo并发症的发生率。还按尿流改道类型比较3级及以上Clavien-Dindo并发症的发生率。采用逻辑回归控制来源机构。
初步分析共纳入199例病例。术前评分系统均不能预测根治性膀胱切除术患者发生≥3级Clavien-Dindo并发症。在二次分析（n = 212，包括部分膀胱切除术）中，与根治性膀胱切除术相关的任何尿流改道类型的并发症发生率均无显著差异。然而，部分膀胱切除术（n = 13）的并发症发生率显著较低。
老年肌层浸润性膀胱癌患者接受膀胱切除术的并发症发生率非常高。对于经病史和体格检查后批准手术的患者，我们的客观指标均不能充分预测手术风险。博尔扎诺组描述的一种独特的改道手术，输尿管-输尿管皮肤造口术，与更常见的改道手术并发症发生率相当。基于该队列的结果，部分膀胱切除术在老年人群围手术期发病率方面似乎是一个特别有利的选择。
