Elderly and bladder cancer: The role of radical cystectomy and orthotopic urinary diversion.

IF 0.8 Q4 UROLOGY & NEPHROLOGY Urologia Journal Pub Date : 2024-08-01 Epub Date: 2024-03-29 DOI:10.1177/03915603241240644
Francesco Pio Bizzarri, Eros Scarciglia, Pierluigi Russo, Filippo Marino, Simona Presutti, Seyed Koosha Moosavi, Mauro Ragonese, Marco Campetella, Carlo Gandi, Angelo Totaro, Giuseppe Palermo, Emilio Sacco, Marco Racioppi
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Abstract

The incidence of bladder cancer (BC) depends on advancing age and other risk factors, significantly impacting on surgical, functional and oncological outcomes. Radical cystectomy (RC) with urinary diversion is the gold standard therapy for muscle invasive bladder cancer; however, it remains a complex surgery and requires careful analysis of risk factors in order to potentially decrease post-surgical complication rates. Age in surgery is a limiting factor that can modify surgical and oncological outcomes, and is correlated with a high rate of post-dimssion hospital readmissions. The reconstruction of the bladder with the intestine represents a crucial point of radical cystectomy and the urinary derivation (UD) is at the center of many debates. A non-continent UD seems to be the best choice in elderly patients (>75 years old), while orthotopic neobladder (ON) is poorly practiced. We reviewed the literature to identify studies reporting outcomes, complications, patient- selection criteria, and quality-of-life data on elderly patients, who underwent ON following radical cystectomy. Reviewing the literature there is no clear evidence on the use of age as an exclusion criterion. Certainly, the elderly patient with multiple comorbidities is not eligible for ON, preferring other UD or rescue therapies. A careful preoperative selection of elderly patients could greatly improve clinical, surgical and oncological outcomes, giving the chance to selected patients to receive an ON.

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老年人与膀胱癌:根治性膀胱切除术和正位尿路转流术的作用。
膀胱癌(BC)的发病率取决于年龄的增长和其他风险因素,对手术、功能和肿瘤结果有重大影响。根治性膀胱切除术(RC)加尿路改道术是治疗肌层浸润性膀胱癌的金标准疗法;然而,它仍然是一种复杂的手术,需要对风险因素进行仔细分析,以降低术后并发症的发生率。手术中的年龄是一个限制因素,会影响手术和肿瘤治疗效果,并且与膀胱切除术后的高再住院率相关。膀胱与肠道的重建是根治性膀胱切除术的一个关键点,而尿路导管(UD)则是许多争论的焦点。对于老年患者(75 岁以上)来说,非连续性 UD 似乎是最好的选择,而正位新膀胱(ON)则很少采用。我们查阅了相关文献,以确定报告老年患者在根治性膀胱切除术后接受正位新膀胱术的结果、并发症、患者选择标准和生活质量数据的研究。综观文献,没有明确的证据表明应将年龄作为排除标准。当然,患有多种并发症的老年患者不适合接受膀胱切除术,他们更愿意接受其他膀胱切除术或抢救疗法。术前对老年患者进行仔细筛选,可以大大改善临床、手术和肿瘤治疗效果,让被选中的患者有机会接受膀胱切除术。
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来源期刊
Urologia Journal
Urologia Journal UROLOGY & NEPHROLOGY-
CiteScore
0.60
自引率
12.50%
发文量
66
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