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Laparoscopic Versus Open Radical Cystectomy for Patients Older than 75 Years: a Single-Center Comparative Analysis

  • Yasui, Takahiro (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Tozawa, Keiichi (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Ando, Ryosuke (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Hamakawa, Takashi (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Iwatsuki, Shoichiro (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Taguchi, Kazumi (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Kobayashi, Daichi (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Naiki, Taku (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Mizuno, Kentaro (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Okada, Atsushi (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Umemoto, Yukihiro (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Kawai, Noriyasu (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Sasaki, Shoichi (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Hayashi, Yutaro (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences) ;
  • Kohri, Kenjiro (Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences)
  • 발행 : 2015.10.06

초록

Background: To explore the safety, efficacy, and oncological outcome of 3-port laparoscopic radical cystectomy (LRC) compared to open radical cystectomy (ORC) in patients older than 75 years. Materials and Methods: From June 2010 to July 2014, we analyzed 16 radical cystectomies in patients older than 75 years (LRC group=8; ORC group=8). Demographic parameters, operative variables, and perioperative outcome in the 2 groups were retrospectively collected, analyzed, and compared. Results: Patients in both groups had comparable preoperative characteristics. A significantly longer operating time (476 vs. 303 min, P=0.0002) and less estimated blood loss (627 vs. 2,106 mL, P=0.021) were observed in the LRC group compared to the ORC group. Infection and ileus were the most common early complications after surgery. Patients who underwent ORC suffered from more postoperative infection (22.2% vs. 0.0%, P=0.054) and ileus (25.0% vs. 12.5%, P=0.521) than the LRC group, but the difference was not significant. Conclusions: Judging from this initial trial, 3-port LRC can be safely carried out in elderly patients. We suggest 3-port LRC as the primary intervention to treat muscle-invasive or high-risk nonmuscle-invasive bladder cancer in elderly patients with an otherwise relatively long life expectancy.

키워드

참고문헌

  1. Bochner BH, Sjoberg DD, Laudone VP (2014). Memorial Sloan Kettering Cancer Center Bladder Cancer Surgical Trials Group. A randomized trial of robot-assisted laparoscopic radical cystectomy. N Engl J Med, 371, 389-90. https://doi.org/10.1056/NEJMc1405213
  2. Bostrom PJ, Kossi J, Laato M, et al (2009). Risk factors for mortality and morbidity related to radical cystectomy. BJU Int, 103, 191-6. https://doi.org/10.1111/j.1464-410X.2008.07889.x
  3. Cabinet Office, Government of Japan (2014). A profile of aging society 2014. Available: http://www8.cao.go.jp/kourei/whitepaper/w-2014/gaiyou/index.html
  4. Chavan S, Bray F, Lortet-Tieulent J, et al (2014). International variations in bladder cancer incidence and mortality. Eur Urol, 66, 59-73. https://doi.org/10.1016/j.eururo.2013.10.001
  5. Eble JN, Sauter G, Epstein Jl, et al (2004). WHO classification of tumours of the urinary system and male genital organs. Lyon: IARCC Press, 29-34.
  6. Froehner M, Brausi MA, Herr HW, et al (2009). Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol, 56, 443-54. https://doi.org/10.1016/j.eururo.2009.05.008
  7. Gakis G, Efstathiou J, Lerner SP, et al (2013). Radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. international consultation on urologic disease-european association of urology consultation on bladder cancer 2012. Eur Urol, 63, 45-57. https://doi.org/10.1016/j.eururo.2012.08.009
  8. Game X, Soulie M, Seguin P, et al (2001). Radical cystectomy in patients older than 75 years: assessment of morbidity and mortality. Eur Urol, 39, 525-9. https://doi.org/10.1159/000052498
  9. Guillotreau J, Game X, Mouzin M, et al (2009). Radical cystectomy for bladder cancer: morbidity of laparoscopic versus open surgery. Radical cystectomy for bladder cancer: morbidity of laparoscopic versus open surgery. J Urol, 181, 554-9.
  10. Guillotreau J, Miocinovic R, Game X, et al (2012). Outcomes of laparoscopic and robotic radical cystectomy in the elderly patients. Urol, 79, 585-90. https://doi.org/10.1016/j.urology.2011.11.042
  11. Horstmann M, Kugler M, Anastasiadis AG et al (2012). Laparoscopic radical cystectomy: initial experience using the single-incision triangulated umbilical surgery (SITUS) technique. World J Urol, 30, 619-24. https://doi.org/10.1007/s00345-012-0909-y
  12. Mendiola FP, Zorn KC, Gofrit ON, et al (2007). Cystectomy in the ninth decade: operative results and long-term survival outcomes. Can J Urol, 14, 3628-34.
  13. Morgan TM, Keegan KA, Barocas DA, et al (2011). Predicting the probability of 90-day survival of elderly patients with bladder cancer treated with radical cystectomy. J Urol, 186, 829-34. https://doi.org/10.1016/j.juro.2011.04.089
  14. Murphy DG, Challacombe BJ, Elhage O, et al (2008). Roboticassisted laparoscopic radical cystectomy with extracorporeal urinary diversion: initial experience.
  15. Nakane A, Akita H, Okamura T, et al (2013). Feasibility of a novel extraperitoneal two-port laparoendoscopic approach for radical prostatectomy: an initial study. Int J Urol, 20, 729-33. https://doi.org/10.1111/iju.12034
  16. Parra RO, Andrus CH, Jones JP, et al (1992). Laparoscopic cystectomy: initial report on a new treatment for the retained bladder. J Urol, 148, 1140-4.
  17. Prout GR Jr, Wesley MN, Yancik R, et al (2005). Age and comorbidity impact surgical therapy in older bladder carcinoma patients: a population-based study. Cancer, 104, 1638-47. https://doi.org/10.1002/cncr.21354
  18. Richards KA, Kader AK, Otto R, et al (2012). Is robotassisted radical cystectomy justified in the elderly? A comparison of robotic versus open radical cystectomy for bladder cancer in elderly $\geq$75 years old. J Endourol, 26, 1301-6. https://doi.org/10.1089/end.2012.0035
  19. Sighinolfi MC, Micali S, Celia A, et al (2007). Laparoscopic radical cystectomy: an Italian survey. Surg Endosc, 21, 1308-11. https://doi.org/10.1007/s00464-006-9086-7
  20. Sobin LH, Gospodariwicz M, Wittekind C (2009). TNM classification of malignant tumors. UICC international union against cancer, 7th ed., Oxford: Wiley- Blackwell, 262-5.
  21. Sogni F, Brausi M, Frea B, et al (2008). Morbidity and quality of life in elderly patients receiving ileal conduit or orthotopic neobladder after radical cystectomy for invasive bladder cancer. Urol, 71, 919-23. https://doi.org/10.1016/j.urology.2007.11.125
  22. Soulie M, Straub M, Game X, et al (2002). A multicenter study of the morbidity of radical cystectomy in select elderly patients with bladder cancer. J Urol, 167, 1325-8. https://doi.org/10.1016/S0022-5347(05)65292-5
  23. Tang K, Li H, Xia D, et al (2014). Laparoscopic versus open radical cystectomy in bladder cancer: a systematic review and meta-analysis of comparative studies. PLoS One, 9, 95667. https://doi.org/10.1371/journal.pone.0095667
  24. Wein A (2012). Campbell-Walsh urology, 10th ed., Philadelphia: Elsevier, 2379-408.
  25. Zebic N, Weinknecht S, Kroepfl D (2005). Radical cystectomy in patients aged > or=75 years: an updated review of patients treated with curative and palliative intent. BJU Int, 95, 1211-4. https://doi.org/10.1111/j.1464-410X.2005.05507.x
  26. Zeng S, Zhang Z, Yu X, et al (2014). Laparoscopic versus open radical cystectomy for elderly patients over 75-year-old: a single center comparative analysis. PLoS One, 9, 98950. https://doi.org/10.1371/journal.pone.0098950

피인용 문헌

  1. Does previous abdominal surgery adversely affect perioperative and oncologic outcomes of laparoscopic radical cystectomy? vol.16, pp.1, 2018, https://doi.org/10.1186/s12957-018-1317-6