Leibovitch I, Avigad I, Ben-Chaim J, Nativ O, Goldwasser B
Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Cancer. 1993 May 15;71(10):3098-101. doi: 10.1002/1097-0142(19930515)71:10<3098::aid-cncr2820711033>3.0.co;2-i.
Although radical cystectomy is accepted by most urologists as the treatment of choice for invasive carcinoma of the bladder and age alone is not considered a contraindication for radical surgery, many consider radical major operations to be unsuitable for elderly patients.
The authors compared the results of radical cystectomy in 42 elderly patients to those in patients 69 years old or younger and to a group of 21 elderly patients, matched by stage of disease and severity of medical problems, who received alternative treatment.
The overall operative mortality rate was 6.3% (seven patients). Three (4.3%) postoperative deaths in the younger group and four (9.5%) deaths among elderly patients were recorded. The operative morbidity and mortality did not differ significantly between those two groups (P = 0.1). Among the patients who received alternative therapy, 13 (61.9%) died within the first 6 months, and only 3 survived more than 12 months. Morbidity was encountered in 97% of these patients.
The authors showed that radical cystectomy is a relatively safe procedure for elderly patients. The elderly patient who is thought to be unsuitable for surgery not only is deprived of his right to definite curative therapy but also is exposed to higher morbidity and mortality and worse quality of life than are those who undergo operations. The authors conclude that it is unjustified to avoid radical cystectomy in the elderly population on the basis of age alone.
尽管根治性膀胱切除术被大多数泌尿外科医生视为浸润性膀胱癌的首选治疗方法，且年龄本身不被视为根治性手术的禁忌证，但许多人认为根治性大手术不适用于老年患者。
作者将42例老年患者的根治性膀胱切除术结果与69岁及以下患者的结果进行比较，并与一组21例按疾病分期和医疗问题严重程度匹配的接受替代治疗的老年患者进行比较。
总体手术死亡率为6.3%（7例患者）。记录到年轻组有3例（4.3%）术后死亡，老年患者中有4例（9.5%）死亡。两组的手术并发症发生率和死亡率无显著差异（P = 0.1）。在接受替代治疗的患者中，13例（61.9%）在最初6个月内死亡，只有3例存活超过12个月。这些患者中有97%出现了并发症。
作者表明，根治性膀胱切除术对老年患者来说是一种相对安全的手术。被认为不适合手术的老年患者不仅被剥夺了接受确定性治愈性治疗的权利，而且与接受手术的患者相比，面临更高的并发症发生率和死亡率以及更差的生活质量。作者得出结论，仅基于年龄而避免对老年人群进行根治性膀胱切除术是不合理的。
