Mally David, John Patricia, Pfister David, Heidenreich Axel, Albers Peter, Niegisch Günter
Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
Department of Urology, University Hospital of Cologne, Cologne, Germany.
Front Surg. 2022 Jun 10;9:803926. doi: 10.3389/fsurg.2022.803926. eCollection 2022.
Ileal conduits (ICs) carry an additional perioperative complication risk due to the bowel procedure. This analysis compares surgical outcomes in patients ≥75 years of age with ureterocutaneostomy (UCN) and IC after cystectomy (Cx).
Data of 527 patients included in a retrospective cystectomy database of two high volume centers (2008-2020) were queried to identify elderly patients (≥75 years) who underwent Cx either with IC or UCN. Patient characteristics of all patients [age, BMI, Charlson Comorbidity Index (CCI)], perioperative parameters (operation time, blood loss, transfusions, tumor stage), and postoperative complications (clavien >IIIA, intensive care unit (ICU) stay) were compared. As special focus, bowel complications requiring surgical revision (rBCs) were analyzed. In patients with IC, the rate of ureteral implantation stenosis (USt) was recorded. As a population of special interest, patients ≥80 years of age were analyzed separately. Categorical data were compared using Fisher exact test, and continuous data were compared using Mann-Whitney U test.
A total of 163 patients ≥75 years of age (125 IC, 38 UCN) were identified. Patients with UCN were older and presented with a higher CCI, though differences were not statistically different. Surgery with palliative intent was more frequent in patients with UCN (37 vs. 10%). Operation time in UCN was significantly shorter (233 vs. 305 min, = 0.02), while blood loss and transfusion rate were comparable. Overall complication rate (Clavien-Dindo grade IIIA-IVB) was comparable (UCN 34% vs. IC 37%). However, rBC was a rare complication in UCN (3/38) as compared to patients with IC (15/125). Frequency of postoperative ICU stay (UCN 16% vs. IC 16%) and 90-day mortality did not differ (UCN 3/38 patients, IC 5/125 patients). Regarding long-term follow-up, USt requiring revision or permanent stenting was seen in 18/125 (14%) patients with IC. In patients >80 years of age, results were comparable to the main cohort. Low event rate regarding complications and bias inherent of a retrospective analysis (selection bias, unequal distribution in case numbers) precludes detection of statistical differences regarding patients' characteristics and overall complication rate.
UCN is an alternative to IC in elderly and/or frail patients. Severe bowel complications are numerically less frequent and operation time is minimized.
由于肠道手术，回肠导管（IC）会带来额外的围手术期并发症风险。本分析比较了年龄≥75岁的患者在膀胱切除术后接受输尿管皮肤造口术（UCN）和IC的手术结果。
查询了两个高容量中心（2008 - 2020年）回顾性膀胱切除术数据库中527例患者的数据，以确定接受IC或UCN膀胱切除术的老年患者（≥75岁）。比较了所有患者的特征[年龄、体重指数、Charlson合并症指数（CCI）]、围手术期参数（手术时间、失血量、输血情况、肿瘤分期）和术后并发症（Clavien>IIIA级、重症监护病房（ICU）住院时间）。特别关注的是，分析了需要手术修正的肠道并发症（rBCs）。在接受IC的患者中，记录输尿管植入狭窄（USt）的发生率。作为特别感兴趣的人群，对年龄≥80岁的患者进行了单独分析。分类数据使用Fisher精确检验进行比较，连续数据使用Mann-Whitney U检验进行比较。
共确定了163例年龄≥75岁的患者（125例IC，38例UCN）。UCN患者年龄更大，CCI更高，尽管差异无统计学意义。UCN患者中姑息性手术更为常见（37%对10%）。UCN的手术时间明显更短（233对305分钟，P = 0.02），而失血量和输血率相当。总体并发症发生率（Clavien-Dindo IIIA-IVB级）相当（UCN为34%，IC为37%）。然而，与IC患者（15/125）相比，rBC在UCN中是一种罕见的并发症（3/38）。术后ICU住院频率（UCN为16%，IC为16%）和90天死亡率无差异（UCN为3/38例患者，IC为5/125例患者）。关于长期随访，125例接受IC的患者中有18例（14%）出现需要修正或永久性支架置入的USt。在年龄>80岁的患者中，结果与主要队列相当。并发症发生率低以及回顾性分析固有的偏差（选择偏差、病例数分布不均）使得无法检测到患者特征和总体并发症发生率方面的统计学差异。
对于老年和/或体弱患者，UCN是IC的一种替代方案。严重肠道并发症在数量上较少见，且手术时间最短。
