在脆弱患者中施行经腹膜外囊切除术并输尿管皮造口术——是否应该更频繁地进行？
Extraperitoneal cystectomy with ureterocutaneostomy derivation in fragile patients - should it be performed more often?
机构信息
Department of Urology, San Martino Hospital, University of Genoa, Genoa.
Department of Urology, Hospitals of Legnano and Magenta, Milan.
出版信息
Arch Ital Urol Androl. 2022 Jun 29;94(2):144-149. doi: 10.4081/aiua.2022.2.144.
INTRODUCTION AND OBJECTIVES
Radical cystectomy (RC) continues to be standard of care for muscle-invasive bladder cancer and recurrent or refractory nonmuscle invasive bladder cancer. Unfortunately, it has high rates of perioperative morbidity and mortality. One of the most important predictors of postoperative outcomes is frailty, while the majority of complications are diversion related. The aim of our study was to evaluate safety of extraperitoneal cystectomy with ureterocutaneostomy in patients considered as frail.
MATERIALS AND METHODS
We retrospectively collected data of frail patients who underwent extraperitoneal cystectomy with ureterocutaneostomy from October 2018 to August 2020 in a single center. We evaluated frailty by assessing patients' age, body mass index (BMI), nutritional status by Malnutrition Universal Screening Tool, overall health by RAI (Risk Analysis Index) and ASA (American Society of Anaesthesiologists) score, and laboratory analyses. We observed intraoperative outcomes and rates of perioperative (within 30 days) and early postoperative (within 90 days) complications (Clavien-Dindo classification). We defined extraperitoneal cystectomy with ureterocutaneostomy as safe if patients did not develop Clavien Dindo IIIb, or worse, complication.
RESULTS
A total of 34 patients, 3 female and 31 male, were analyzed. The median age was 77, BMI 26, RAI 28, ASA 3 and the majority had preexisting renal insufficiency. Blood analyses revealed presence of severe preoperative hypoalbuminemia and anemia in half of our cohort. Intraoperative median blood loss was 250 cc, whilst operative time 245 min. During perioperative period 60% of our cohort developed Clavien Dindo II complication and during early postoperative period 32% of patients required readmission. One death occurred during early postoperative period (2.9%). After 12 months of follow-up, we observed stability of the renal function for most patients.
CONCLUSIONS
We believe that extraperitoneal cystectomy with ureterocutaneostomy could be considered as a treatment option for elderly and/or frail patients.
介绍和目的
根治性膀胱切除术（RC）仍然是肌层浸润性膀胱癌和复发性或难治性非肌层浸润性膀胱癌的标准治疗方法。不幸的是，它具有较高的围手术期发病率和死亡率。术后结局的最重要预测因素之一是虚弱，而大多数并发症与引流管有关。我们研究的目的是评估在被认为虚弱的患者中进行经腹膜外膀胱切除术和输尿管皮造口术的安全性。
材料和方法
我们回顾性收集了 2018 年 10 月至 2020 年 8 月在单中心接受经腹膜外膀胱切除术和输尿管皮造口术的虚弱患者的数据。我们通过评估患者的年龄、体重指数（BMI）、营养不良通用筛查工具评估的营养状况、整体健康状况（风险分析指数）和美国麻醉医师协会（ASA）评分以及实验室分析来评估虚弱程度。我们观察了术中结果以及围手术期（30 天内）和早期术后（90 天内）并发症（Clavien-Dindo 分类）的发生率。如果患者未发生 Clavien Dindo IIIb 或更严重的并发症，我们将经腹膜外膀胱切除术和输尿管皮造口术定义为安全。
结果
共分析了 34 名患者，其中 3 名女性和 31 名男性。中位年龄为 77 岁，BMI 为 26，RAI 为 28，ASA 为 3，大多数患者存在先前存在的肾功能不全。血液分析显示，我们队列的一半患者术前存在严重的低白蛋白血症和贫血。术中中位失血量为 250cc，手术时间为 245 分钟。在围手术期，我们队列的 60%患者发生了 Clavien Dindo II 级并发症，在早期术后期间，32%的患者需要再次入院。1 例患者在早期术后期间死亡（2.9%）。在 12 个月的随访后，我们观察到大多数患者的肾功能稳定。
结论
我们认为，经腹膜外膀胱切除术和输尿管皮造口术可作为老年和/或虚弱患者的治疗选择。
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