Laparoscopic versus open radical cystectomy for elderly patients over 75-year-old: a single center comparative analysis.
Laparoscopic versus open radical cystectomy for elderly patients over 75-year-old: a single center comparative analysis.
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75 岁以上老年患者腹腔镜与开腹根治性膀胱切除术的单中心比较分析
DOI：
10.1371/journal.pone.0098950
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Xu C
中科院分区：
文献类型：
--
作者：
Zeng S;Zhang Z;Yu X;Song R;Wei R;Zhao J;Wang L;Hou J;Sun Y;Xu C
目的探讨腹腔镜根治性膀胱切除术（LRC）与开放式根治性膀胱切除术（ORC）在75岁以上老年患者中的发病率、死亡率和肿瘤学结果。材料与方法我们分析我院2009年1月至2013年12月75岁以上患者行根治性膀胱切除术46例，其中LRC组21例，ORC组25例。回顾性收集两组患者的人口学参数、手术变量及围手术期预后。围手术期发病和死亡按发病时间分为早期（术后90天内）和晚期（术后90天以上）。结果两组患者术前特征相当。与ORC组相比，LRC组的手术时间明显更长（418 vs. 337 min, p = 0.018），估计失血量明显减少（400 vs. 500 ml p = 0.038）。感染和肠梗阻是术后最常见的早期并发症。ORC组术后90天内肠梗阻发生率（28.0% vs. 4.8%, P = 0.038）和感染发生率（40% vs. 9.5%, P = 0.019）明显高于LRC组。LRC组和ORC组的死亡率分别为4.7%（1/21）和4%（1/25）。在中位随访21个月（范围2-61个月）时，Kaplan-Meier生存曲线和log-rank分析表明，LRC组和ORC组在3年总体生存率、癌症特异性生存率或无复发生存率方面没有显著差异。结论对于预期寿命较长的老年患者，推荐LRC作为治疗肌肉浸润性或高危非肌肉浸润性膀胱癌的首选干预措施。
Purpose To explore the morbidity, mortality and oncological results of laparoscopic radical cystectomy (LRC) in the elderly patients over 75-year-old in contrast with open radical cystectomy (ORC). Materials and Methods We analyzed 46 radical cystectomies from January 2009 to December 2013 in patients over 75-year-old in our institute, 21 patients in the LRC group and 25 in the ORC group. Demographic parameters, operative variables and perioperative outcome were retrospectively collected and analyzed between the two groups. Perioperative morbidity and mortality were categorized as early (within 90 days after surgery) or late (more than 90 days) according to the time of occurrence. Results Patients in both groups had comparable preoperative characteristics. A significant longer operative time (418 vs. 337 min, p = 0.018) and less estimated blood loss (400 vs. 500 ml p = 0.038) were observed in LRC group compared with ORC group. Infection and ileus were the most common early complications after surgery. Patients underwent ORC suffered from significantly more postoperative ileus (28.0% vs. 4.8%, P = 0.038) and infection (40% vs. 9.5%, P = 0.019) than LRC group within 90 days after surgery. The mortality rate was 4.7% (1/21) and 4% (1/25) for LRC group and ORC group respectively. At a median follow-up of 21 months (range 2–61 months), the Kaplan-Meier survival curves and log-rank analysis demonstrate that there were no significant differences between the LRC and ORC groups in the 3-year overall, cancer-specific, or recurrence-free survival rates. Conclusions It is suggested that LRC should be recommended as the primary intervention to treat muscle invasive or high risk non-muscle invasive bladder cancer in elderly patients with a relative long life expectancy.
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影响因子：
6.2
作者：
Prout, GR;Wesley, MN;Edwards, BK
通讯作者：
Edwards, BK
影响因子：
6.6
作者：
Guillotreau, Julien;Game, Xavier;Rischmann, Pascal
通讯作者：
Rischmann, Pascal
影响因子：
254.7
作者：
Siegel, Rebecca;Naishadham, Deepa;Jemal, Ahmedin
通讯作者：
Jemal, Ahmedin
影响因子：
6.6
作者：
Chang, SS;Alberts, G;Smith, JA
通讯作者：
Smith, JA
影响因子：
2.1
作者：
Guillotreau, Julien;Miocinovic, Ranko;Haber, Georges-Pascal
通讯作者：
Haber, Georges-Pascal