腹腔鏡膀胱切除對年紀≧65歲併多重共病的老人的可行性
陳昭安1、林威宇1、邱國雄1、張殷綸1、黃國財1
、林健煇1、黃雲慶1、何東儒1、陳志碩1、楊紫馨1
1嘉義長庚紀念醫院外科部泌尿外科
Feasibility and Outcomes of Radical Cystectomy for Bladder Cancer in the Older Patients (Age>65 y/o)
Chao-An Chen1, Wei-Yu Lin1, Kuo-Hsiung Chiu11, Yin-Lun Chang1, Kuo-Cai Huang1
, Jian-Hui Lin1, Yung-Chin Huang1, Dong-Ru Ho1, Chih-Shou Chen1 Tzu-Hsin Yang1,
1Division of Urology, Department of Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
陳昭安1 ,林威宇1, 邱國雄1,張殷綸1,黃國財1,
林健煇1,黃雲慶1,何東儒1,陳志碩1,楊紫馨1
嘉義長庚醫院外科部泌尿外科1
OBJECTIVES
To report our experience with radical cystectomy by open or laparoscopy method as applied to an older patient population with regard to perioperative measures and pathologic outcomes.
METHODS
A total of 48 patients underwent cystectomy and extracorporeal urinary diversion at our institution from September 2008 through March 2016 for clinically localized bladder cancer. The clinical characteristics, operative outcomes, and pathologic results of the consecutive cases were categorized by age (younger, age <65 years vs older, age ≧65 years).
RESULTS
The outcomes of the 21 younger and 27 older patients, including 10 patients ≧_80 years old, were assessed. The number of patients received cystectomy by open vs. laparoscopy method in the younger and older groups were 7 vs.14 and 12 vs.11, respectively. The numbers of different urine diversions methods (young vs .old) were1vs. 5 (ureterocutaneostomy), 10 vs.10 (ileal conduit), 4 vs.6 (neobladder). No differences were observed between the 2groups in American Society of Anesthesiologists score, operation time, blood loss, time to discharge, complication rate, open conversion rate, 30-D and 90-D mortality rate. Also, no significant differences were found in the surgical pathologic findings, including the organ-confined rate and lymph node yield
CONCLUSIONS
Older patients do not appear to have any significant differences or compromises with regard to the perioperative and pathologic outcomes after radical cystectomy by either open or laparoscopy method and urine diversion with or without neobladder. Thus age alone should not preclude radical cystectomy or for certain type of urine diversion.