Abstract
The aim of this study was to compare the morbidity, mortality, oncological results and quality of life between laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC) in the elderly patients over 75 years old. Between January 2012 and January 2015, 60 patients were recruited into this study, who were randomly assigned in a 1:1 ratio to either LRC or ORC group. Baseline patient characteristics, pathological factors, operative and postoperative characteristics, postoperative complications and survival data were retrospectively collected, analyzed and compared between the two groups. Patients in LRC group and ORC group had comparable baseline characteristics and pathological factors (all P > 0.05). LRC group required longer operative time (408.2 ± 76.9 vs. 311.7 ± 65.3 min, P = 0.000) and had less EBL (621.6 ± 100.7 vs. 1088.5 ± 109.4 ml, P = 0.000) compared with ORC group. The incidence of infection and ileus within 90 days after surgery in ORC group was significantly higher than LRC group(6.9% vs. 28.6%, P = 0.041; 3.4% vs. 25%, P = 0.025). At a median follow-up of 28 months (range 12–48 months), the survival analysis showed that there were no significant differences between the LRC and ORC groups in overall survival (log-rank χ2 = 0.122; P = 0.726), or progress-free survival (log-rank χ2 = 0.153; P = 0.696). In conclusion, this study confirmed that LRC could achieve similar tumor treatment efficacy compared to ORC, with fewer perioperative complications and less blood loss. We suggest that LRC should be considered as the primary intervention for patients aged over 75 years old with muscle invasive bladder cancer or non-muscle invasive bladder cancer with high risk factors.
Highlights
Bladder cancer (BC), characterized by high risk of recurrence and mortality, is among the fifth most common malignancies in the world [1]
Between January 2012 and January 2015, 60 patients were recruited into this study, who were randomly assigned in a 1:1 ratio to either laparoscopic radical cystectomy (LRC) or open radical cystectomy (ORC) group
The incidence of infection and ileus within 90 days after surgery in ORC group was significantly higher than LRC group(6.9% vs. 28.6%, P = 0.041; 3.4% vs. 25%, P = 0.025)
Summary
Bladder cancer (BC), characterized by high risk of recurrence and mortality, is among the fifth most common malignancies in the world [1]. Radical cystectomy (RC) combined with pelvic lymphadenectomy is a standard treatment for myometrial invasive bladder cancer, which can improve the survival rate of patients with invasive bladder cancer and avoid local recurrence and distant metastasis [3]. Open radical cystectomy (ORC) has definite curative effect, but there are many deficiencies, such as trauma, blood loss, slow recovery and so on [4]. Patients, especially those over 75 years old, usually have more comorbidities, and have a higher incidence of complications and mortality. It is necessary to find a more effective and appropriate treatment method for the elderly patients with bladder cancer
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