Porav-Hodade Daniel, Big Silvestru-Alexandru, Barbos Vlad-Ilie, Gherle Bogdan, Jerzicska Ernő, Ona Victor, Feciche Bogdan-Ovidiu
Department of Urology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania.
Department of Urology, Clinical County Hospital Mures, 540136 Târgu Mures, Romania.
Clin Pract. 2024 Nov 24;14(6):2559-2567. doi: 10.3390/clinpract14060201.
: Radical cystectomy (RC) represents one of the most complex and morbid surgical procedures in the field of Urology. Extraperitoneal open RC has emerged as an alternative to the traditional transperitoneal approach for the treatment of muscle-invasive bladder cancer. Frailty is one of the most important risk factors for perioperative morbidity and mortality, and this category of patients can benefit the most from the extraperitoneal approach. The purpose of this study was to evaluate the feasibility and the safety of extraperitoneal open RC in our experience; : We retrospectively collected the data of 75 frail patients who underwent an extraperitoneal open RC, performed by a single experienced surgeon. We assessed their frailty status using the simplified frailty index (sFI). We recorded data regarding general characteristics, intraoperative, pathological, and postoperative complications, and mortality (within 90 days); We analyzed 61 males and 14 females with an sFI equal to or higher than 3. The median age was 77 years. Fifty-one patients had an ASA score of 3 or more. Sixty procedures were with radical intention, while fifteen were palliative. Cutaneous ureterostomy was performed in 70 cases and extraperitonized ileal conduit in five cases. The median operative time was 150 min. The median blood loss was 400 mL. The median time to flatus was 2 days. The median postoperative stay was 7 days. Thirteen patients had Clavien-Dindo III or IV complications. Two patients died in first 90 days postoperatively; : The extraperitoneal open RC in frail patients was demonstrated to be a feasible and safe alternative approach in definitive treatment or a palliative setting in our experience.
根治性膀胱切除术（RC）是泌尿外科领域最复杂、创伤最大的手术之一。腹膜外开放性RC已成为治疗肌层浸润性膀胱癌的传统经腹途径的替代方法。虚弱是围手术期发病和死亡的最重要危险因素之一，这类患者从腹膜外途径中获益最大。本研究的目的是评估我们经验中腹膜外开放性RC的可行性和安全性。我们回顾性收集了75例由一位经验丰富的外科医生实施腹膜外开放性RC的虚弱患者的数据。我们使用简化虚弱指数（sFI）评估他们的虚弱状态。我们记录了有关一般特征、术中、病理和术后并发症以及死亡率（90天内）的数据。我们分析了61例男性和14例女性，其sFI等于或高于3。中位年龄为77岁。51例患者的美国麻醉医师协会（ASA）评分为3分或更高。60例手术为根治性，15例为姑息性。70例行皮肤输尿管造口术，5例行腹膜内回肠代膀胱术。中位手术时间为150分钟。中位失血量为400毫升。中位排气时间为2天。中位术后住院时间为7天。13例患者出现Clavien-Dindo III或IV级并发症。2例患者在术后90天内死亡。根据我们的经验，腹膜外开放性RC在虚弱患者的确定性治疗或姑息治疗中被证明是一种可行且安全的替代方法。
