Stroumbakis N, Herr H W, Cookson M S, Fair W R
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
J Urol. 1997 Dec;158(6):2113-7. doi: 10.1016/s0022-5347(01)68171-0.
We evaluated the morbidity and outcome of cystectomy and urinary diversion in patients 80 years old or older with invasive bladder cancer.
We reviewed the records of all patients older than 80 years who underwent cystectomy during the last 15 years. Of 1,186 cystectomies 44 patients (4%) were identified. Patients were evaluated for complications, mortality and functional status after surgery.
The 44 patients had a median age of 81 years (range 80 to 87). Of the patients 78% had significant co-morbidity, including 41% with 2 or more medical problems. Median hospital stay was 14 days, with 20% of the patients requiring intensive care for 24 hours. There was a 51% complication rate including 25% due to surgical complications and 26% from underlying medical illness. Operative mortality was 4.5%. Within 6 months of surgery 66% were rehospitalized for medical or surgical reasons. Median survival time was 25 months. Median performance status before and after surgery decreased slightly from 70 to 65.
The results of this study support the use of cystectomy in octogenarians with invasive bladder cancer. Surgery can be accomplished with acceptable morbidity and mortality. Radical cystectomy in this population offers the best opportunity for sustained disease-free quality survival.
我们评估了80岁及以上浸润性膀胱癌患者行膀胱切除术及尿流改道的发病率及预后情况。
我们回顾了过去15年中所有年龄超过80岁且接受膀胱切除术患者的记录。在1186例膀胱切除术中，共识别出44例患者（4%）。对患者术后的并发症、死亡率及功能状态进行了评估。
44例患者的中位年龄为81岁（范围80至87岁）。其中78%的患者存在显著的合并症，包括41%的患者有2种或更多的医疗问题。中位住院时间为14天，20%的患者需要24小时重症监护。并发症发生率为51%，其中25%为手术并发症，26%为基础疾病所致。手术死亡率为4.5%。术后6个月内，66%的患者因医疗或手术原因再次住院。中位生存时间为25个月。术前及术后的中位体能状态从70略微降至65。
本研究结果支持对80岁以上浸润性膀胱癌患者行膀胱切除术。手术可在可接受的发病率和死亡率情况下完成。该人群行根治性膀胱切除术为实现无病高质量生存提供了最佳机会。
