Περίληψη:
Background: Radical cystectomy (RC) is probably underused in elderly
patients due to a potential increased postoperative complication risk,
as reflected by their considerable comorbidities. Our objective was to
estimate the overall complication rate and investigate a potential
benefit to patients over the age of 75 subjected to RC in terms of
disease-free survival.
Methods: A total of 81 patients, 61 men and 20 women, from two
urological departments, with a mean age of 79.2 +/- 3.7 years,
participated in the study. The mean follow-up period was 2.6 +/- 1.6
years. All patients underwent RC with pelvic lymphadenectomy. An ileal
conduit, an orthotopic ileal neobladder and cutaneous ureterostomies
were formed in 48.1%, 6.2% and 45.7% of the patients, respectively.
The perioperative and 90-day postoperative complications were recorded
and classified according to the modified Clavien classification system.
Survival plots were created based on the oncological outcome and several
study parameters.
Results: The perioperative morbidity rate was 43.2%; the 90-day
morbidity rate was 37%, while the 30-day, 90-day and overall mortality
rates were 3.7%, 3.7% and 21%, respectively. Overall mortality rates
were recorded at the final year of data gathering (2009). Increased age,
increased body mass index (BMI), longer hospitalization and age-adjusted
Charlson comorbidity index (ACCI) more than six, were associated with
greater hazard for 90-day morbidity. The cumulative mortality
/metastasis-free rates for one, two, three and five years were 88.7%,
77.5%, 70.4%, and 62.3%, respectively. Tumour stage and positive
nodes were prognostic predictors for oncological outcome.
Conclusions: RC in patients over 75 is justified and feasible, due to
acceptable complication rates and high 5-year cancer-specific survival,
which support an aggressive approach. Prospective studies are needed for
the verification of the above results.
Συγγραφείς:
Tyritzis, Stavros I.
Anastasiou, Ioannis
Stravodimos,
Konstantinos G.
Alevizopoulos, Aristeides
Kollias, Anastasios
and Balangas, Antonios
Katafigiotis, Ioannis
Leotsakos, Ioannis
and Mitropoulos, Dionysios
Constantinides, Constantinos A.
