Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, 770-8503, Tokushima, Japan.
Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, 770-8539, Tokushima, Japan.
BMC Urol. 2022 Nov 7;22(1):174. doi: 10.1186/s12894-022-01123-3.
Robot-assisted radical cystectomy (RARC) and intracorporeal urinary diversion are less invasive than conventional procedures. However, for older patients, cutaneous ureterostomy (CUS) may be preferred because urinary diversion using the intestine has a high incidence of perioperative complications and is highly invasive. The purpose of this study was to demonstrate the safety and efficacy of intracorporeal ileal conduit (ICIC) compared with CUS in patients aged 75 years or older who underwent RARC.
From October 2014 to December 2021, 82 patients aged 75 years or older who underwent RARC at Tokushima University Hospital, Tokushima Prefectural Central Hospital, or Ehime Prefectural Central Hospital were retrospectively reviewed. Of these, 52 and 25 patients who underwent ICIC and CUS, respectively, were included. After adjusting the patients' characteristics using propensity score-matching, surgical results and prognoses were retrospectively compared. The propensity score was based on age, Eastern Cooperative Oncology Group Performance Status Scale (ECOG-PS), American Society of Anesthesiologists physical status classification (ASA-PS), clinical tumor stage, and neoadjuvant chemotherapy.
The median age was lower in the ICIC group compared with the CUS group, and the proportion of high-risk cases (ECOG-PS ≥ 2 or ASA-PS ≥ 3) did not differ. The median operation time was longer in the ICIC group, and estimated blood loss was higher, compared with the CUS group. There were no significant differences in the incidence of complications within the first 30 postoperative days, incidence of complications 30-90 days after surgery, 2-year overall survival, 2-year cancer-specific survival, and 2-year recurrence-free survival. The stent-free rate was significantly lower in the CUS group than that in the ICIC group.
In older patients, the ICIC group showed non-inferior surgical and oncological outcomes compared with the CUS group. Urinary diversion following RARC in older patients should be carefully selected by considering not only the age but also the general condition (including comorbidities) of the patient.
机器人辅助根治性膀胱切除术（RARC）和腔内尿路分流术比传统手术具有更小的侵袭性。然而，对于老年患者，皮输尿管造口术（CUS）可能更为优选，因为使用肠进行尿路分流术具有较高的围手术期并发症发生率，并且具有高度侵袭性。本研究的目的是证明与 CUS 相比，在接受 RARC 的 75 岁或以上的患者中，腔内回肠导管（ICIC）的安全性和有效性。
2014 年 10 月至 2021 年 12 月，对在德岛大学医院、德岛县立中央医院或爱媛县立中央医院接受 RARC 的 82 名 75 岁或以上的患者进行了回顾性分析。其中，分别有 52 名和 25 名患者接受了 ICIC 和 CUS。使用倾向评分匹配调整患者特征后，回顾性比较了手术结果和预后。倾向评分基于年龄、东部合作肿瘤学组表现状态量表（ECOG-PS）、美国麻醉医师协会身体状况分类（ASA-PS）、临床肿瘤分期和新辅助化疗。
ICIC 组的中位年龄低于 CUS 组，高危病例（ECOG-PS≥2 或 ASA-PS≥3）的比例无差异。ICIC 组的中位手术时间较长，估计失血量高于 CUS 组。术后 30 天内并发症发生率、术后 30-90 天并发症发生率、2 年总生存率、2 年癌症特异性生存率和 2 年无复发生存率无显著差异。CUS 组无支架组的比例明显低于 ICIC 组。
在老年患者中，ICIC 组与 CUS 组的手术和肿瘤学结果无差异。在考虑患者年龄的同时，还应考虑患者的一般状况（包括合并症），对老年患者的 RARC 后进行尿路分流术进行仔细选择。
