Abstract
PurposeTo 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 MethodsWe 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.ResultsPatients 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.ConclusionsIt 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.
Highlights
With marked improvements in medical technology and health care, the average life span of the general population in most countries has progressively increased
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 laparoscopic radical cystectomy (LRC) group compared with open radical cystectomy (ORC) group
At a median follow-up of 21 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
Summary
With marked improvements in medical technology and health care, the average life span of the general population in most countries has progressively increased. [2] the incidence of bladder cancer was rising with the increasing number of older people in China, ranking 1st in the Chinese urinary malignant tumor and reaching a peak over age 85 with an incidence of 69.7/100,000 [3]. It is important but still a conundrum for most urologists to treat elderly patients with muscle invasive or high risk non-muscle invasive bladder cancer. Mortality and oncological results of LRC in the elderly patients more than 75year-old, we conducted such a retrospective single center study with a control group of ORC elderly patients
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