Perioperative morbidity and mortality of octogenarians treated by radical cystectomy-a multi-institutional retrospective study in Japan.
Perioperative morbidity and mortality of octogenarians treated by radical cystectomy-a multi-institutional retrospective study in Japan.
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DOI：
10.1093/jjco/hyx062
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发表时间：
2017-08-01
影响因子：
2.4
通讯作者：
Shinohara N
中科院分区：
文献类型：
--
作者：
Abe T;Takada N;Kikuchi H;Matsumoto R;Osawa T;Murai S;Miyajima N;Maruyama S;Shinohara N
日本老年人在根治性膀胱切除术后发生了类似的围手术期合并症。高龄不应作为放弃RC的单一标准;必须进行仔细的术前评估。确定日本老年人根治性膀胱切除术后90天发病率和死亡率的特征。回顾性多机构研究。我们回顾了1997年至2010年期间接受开放性根治性膀胱切除术的834例患者的记录。所有术后90天内的并发症被分为11个类别，由纪念斯隆-凯特琳癌症中心提出的，并根据修改后的Clavien-Dindo系统分级。我们比较了≥80岁组（n = 86）和<80岁组（n = 748）的并发症特征。多元回归模型用于确定并发症的预测因素。与<80岁组相比，≥80岁组中美国麻醉医师协会评分III-IV更常见（分别为14%和6%，P < 0.0001），输尿管皮肤造口术更常见（分别为30%和21%，P = 0.0148）。两组之间的任何并发症、重大（3-5级）并发症或90天死亡率均无显著差异（≥80岁组：分别为70%、21%、3.5%;<80岁组：分别为68%、22%、2%）。≥80岁组的泌尿生殖系统并发症较少（分别为7% vs. 16%，P = 0.0131）。多变量回归分析显示，肠内尿流改道（P = 0.0031）和手术时间（P = 0.0269）是任何级别并发症的重要预测因子，男性（P = 0.0167）、年膀胱容量（P = 0.0284）和既往心血管合并症（P = 0.0034）是严重并发症的重要预测因子。在我们的经验中，日本老年人的根治性化疗引起了类似的围手术期合并症。高龄不应作为放弃根治性膀胱切除术的单一标准，术前必须仔细评估。
Japanese octogenarians developed similar perioperative comorbidities after radical cystectomy. Old age as a single criterion should not be used to abandon RC; careful preoperative assessment is mandatory. To determine the characteristics of 90-day morbidity and mortality after radical cystectomy in Japanese octogenarians. A retrospective multi-institutional study. We reviewed the records of 834 patients treated by open radical cystectomy between 1997 and 2010. All complications within 90 days after surgery were sorted into the 11 categories proposed by the Memorial Sloan-Kettering Cancer Center and graded according to the modified Clavien-Dindo system. We compared the characteristics of complications between ≥80-year (n = 86) and <80-year (n = 748) groups. Multivariate regression models were used to determine the predictors of complications. American Society of Anesthesiologists score III–IV was more frequent (14% vs. 6%, respectively, P < 0.0001), and ureterocutaneostomy was more frequently performed (30% vs. 21%, respectively, P = 0.0148) in the ≥80-year group compared with <80-year group. There were no significant differences in the rates of any complication, major (Grade 3–5) complication, or 90-day mortality between the two groups (≥80-year group: 70%, 21%, 3.5%, respectively, <80-year group: 68%, 22%, 2%, respectively). The ≥80-year group had fewer genitourinary complications (7% vs. 16%, respectively, P = 0.0131). Multivariate regression analyses revealed that bowel-using urinary diversion (P = 0.0031) and the operative time (P = 0.0269) were significant predictors of any grade of complications, and a male sex (P = 0.0167), annual cystectomy volume (P = 0.0284) and prior cardiovascular comorbidity (P = 0.0034) were significant predictors of major complications. In our experience, radical cystectomy in Japanese octogenarians caused similar perioperative comorbidities. Old age as a single criterion should not be used to abandon radical cystectomy; careful preoperative assessment is mandatory.
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影响因子：
3
作者：
Tanaka, Shogo;Yamamoto, Takatsugu;Ono, Koichi
通讯作者：
Ono, Koichi
影响因子：
6.3
作者：
Cerantola, Yannick;Valerio, Massimo;Patel, Hitendra R. H.
通讯作者：
Patel, Hitendra R. H.
影响因子：
4.5
作者：
Leow, Jeffrey J.;Reese, Stephen;Chang, Steven L.
通讯作者：
Chang, Steven L.
影响因子：
2.1
作者：
Hollenbeck, BK;Miller, DC;Wei, JT
通讯作者：
Wei, JT
影响因子：
1.6
作者：
Berger, Ingrid;Wehrberger, Clemens;Madersbacher, Stephan
通讯作者：
Madersbacher, Stephan