Radical cystectomy is safe in elderly patients at high risk
Radical cystectomy is safe in elderly patients at high risk
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DOI：
10.1016/s0022-5347(05)65868-5
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发表时间：
2001-09-01
影响因子：
6.6
通讯作者：
Smith, JA
中科院分区：
文献类型：
--
作者：
Chang, SS;Alberts, G;Smith, JA
目的：根治性膀胱切除术是健康个体膀胱癌的标准治疗方法。我们确定的安全性根治性cysteine在老年患者在highrisk.Materials和方法：我们回顾了1994年1月至2000年6月期间在我们的机构接受根治性cysteine的所有患者的记录。在这382例患者中，我们确定了44例老年高危患者，定义为年龄≥ 75岁，美国麻醉医师协会分级≥ 3级。我们研究了术后护理，围手术期的轻微/重大并发症，死亡率和需要再住院rehabilitation.Results：44例患者的中位年龄为77.5岁（范围75至87）。美国麻醉医师协会分级为3/40例患者和4/4例患者。中位住院时间为7天（范围4 - 20天）。术后44例患者中的31例（70%）直接转移到普通泌尿外科楼层，而30%的患者术后需要心脏监测。其中9名患者被转移到降压病房，其余4名患者需要进入外科重症监护室。轻微并发症10例（22.7%），严重并发症2例（4.5%）。无患者在围手术期死亡，4例患者住院6个月内出院home.Conclusions：我们的研究结果支持的安全性，根治性化疗在老年患者中的高风险。可接受的围手术期发病率和死亡率可能会达到没有常规的术后强化监测。
Purpose: Radical cystectomy is standard treatment for bladder cancer in healthy individuals. We determined the safety of radical cystectomy in elderly patients at high risk.Materials and Methods: We reviewed the records of all patients who underwent radical cystectomy at our institution between January 1994 and June 2000. Of these 382 patients we identified 44 who were elderly and at high risk, as defined by age 75 years or greater and American Society of Anesthesiologists classification 3 or greater. We examined postoperative care, perioperative minor/major complications, the mortality rate and the need for rehospitalization.Results: Median age of the 44 patients was 77.5 years (range 75 to 87). American Society of Anesthesiologists class was 3 in 40 patients and 4 in 4. Median hospitalization was 7 days (range 4 to 20). Postoperatively 31 of the 44 patients (70%) were transferred directly to the general urology floor, while cardiac monitoring was required postoperatively in 30%. Nine of these patients were transferred to a step-down unit and the remaining 4 required surgical intensive care unit admission. Minor and major complications developed in 10 (22.7%) and 2 (4.5%) cases, respectively. No patients died in the perioperative period and 4 patients were hospitalized within 6 months of discharge home.Conclusions: Our results support the safety of radical cystectomy in elderly patients at high risk. Acceptable perioperative morbidity and mortality may be achieved without routine intensive monitoring postoperatively.