Radikalna cistektomija kod bolesnika u odmaklom životnom dobu

  • Vladimir Bančević Clinic of Urology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy; University of Defence, Belgrade, Serbia
  • Predrag Aleksić Clinic of Urology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy; University of Defence, Belgrade, Serbia
  • Novak Milović Clinic of Urology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy; University of Defence, Belgrade, Serbia
  • Aleksandar Spasić Clinic of Urology, Military Medical Academy, Belgrade, Serbia
  • Božidar Kovaćević Institute of Pathology and Forensic Medicine, Military Medical Academy, Belgrade, Serbia
  • Perica Toševski Clinic of Urology, Military Medical Academy, Belgrade, Serbia
  • Zoran Čampara Clinic of Urology, Military Medical Academy, Belgrade, Serbia
  • Radovan Milošević Clinic of Urology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy; University of Defence, Belgrade, Serbia
  • Snežana Cerović Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Institute of Pathology and Forensic Medicine, Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/5038
Ključne reči: urinary bladder neoplasms||, ||mokraćna bešika, neoplazme, cytectomy||, ||cistektomija, aged||, ||stare osobe, hematuria||, ||hematurija, comorbidity||, ||komorbiditet, postoperative complications||, ||postoperativne komplikacije,

Sažetak


Uvod/Cilj. Radikalna cistektomija je metoda izbora za lečenje mišićnoinvazivnog karcinoma mokraćne bešike. Spada u grupu najvećih operacija u urologiji i povezana je sa brojnim komplikacijama, naročito kod starijih. Cilj ove studije bila je analiza preoperativnog komorbiditeta kao i intraoperativnih i postoperativnih komplikacija kod bolesnika starijih od 75 godina. Metode. U kliničku, retrospektivnu studiju bilo je uključeno 46 bolesnika starijih od 75 godina kojima je učinjena radikalna cistektomija. Praćene su indikacije za operaciju, kao i komplikacije tokom i nakon operacije. Rezultati. Preoperativno, 76% bolesnika imalo je anemiju uzrokovanu hematurijom. Kod 52% operisanih derivacija urina izvedena je ilealnim konduitom, kod 35% ureterokutaneostomijom, a kod 13% bolesnika kreirana je ortotopna ilealna neobešika. Prosečno vreme trajanja operacije iznosilo je 190 (120–300) min. Intraoperativno, 76% bolesnika primalo je transfuziju krvi, prosečno 630 (310–1230) mL. Kod 26% operisanih ustanovljen je tranzicioni ćelijski karcinom (TCC) mokraćne bešike u stadijumu T2, kod 4% u stadijumu T3a, kod 52% u stadijumu T3b, a 14% u stadijumu T4a. Kod jednog bolesnika radilo se o planocelularnom karcinomu, a kod dva bolesnika karcinom prostate dijagnostikovan je incidentalno. Prosečna dužina hospitalizacije nakon operacije iznosila je 16 (8–35) dana. Zaključak. Glavni razlog za cistektomiju kod bolesnika u osmoj i devetoj deceniji života bila je masivna hematurija uzrokovana TCC-om sa posledičnom anemijom, koji nisu mogli biti rešeni endoskopskim putem i transfuzijama krvi. U ovoj populaciji zabeležen je očekivano produžen boravak u bolnici nakon cistektomije, kao i veća stopa komplikacija.

Biografija autora

Vladimir Bančević, Clinic of Urology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy; University of Defence, Belgrade, Serbia
Dept of Urology

Reference

Witjes JA, Compérat E, Cowan NC, De Santis M, Gakis G, Lebret T, et al. EAU Guidelines on Muscle-invasive and Metastatic-Bladder Cancer: Summary of the 2013 Guidelines. Eur Urol 2014; 65(4): 778−92.

May M, Fritsche HM, Gilfrich C, Brookman-May S, Burger M, Otto W, et al. Influence of older age on survival after radical cys-tectomy due to urothelial carcinoma of the bladder: survival analysis of a German multi-centre study after curative treat-ment of urothelial carcinoma of the bladder. Urologe A 2011; 50(7): 821−9.

Froehner M, Brausi MA, Herr HW, Muto G, Studer UE. Compli-cations following radical cystectomy for bladder cancer in the elderly. Eur Urol 2009; 56(3): 443−54.

Large MC, Reichard C, Williams JT, Chang C, Prasad S, Leung Y, et al. Incidence, risk factors, and complications of postoperative delirium in elderly patients undergoing radical cystectomy. Urology 2013; 81(1): 123−8.

Nagele U, Anastasiadis AG, Stenzl A, Kuczyk M. Radical cystect-omy with orthotopic neobladder for invasive bladder cancer: a critical analysis of long-term oncological, functional, and quali-ty of life results. World J Urol 2012; 30(6): 725−32.

Smit SG. Heyns CF. Management of radiation cystitis. Nat Rev Urol 2010; 7(4): 206−14.

Sogni F, Brausi M, Frea B, Martinengo C, Faggiano F, Tizzani A, et al. Morbidity and quality of life in elderly patients receiving ileal conduit or orthotopic neobladder after radical cystectomy for invasive bladder cancer. Urology 2008; 71(5): 919−23.

Tyritzis SI, Anastasiou I, Stravodimos KG, Alevizopoulos A, Kollias A, Balangas A, et al. Radical cystectomy over the age of 75 is safe and increases survival. BMC Geriatrics 2012; 12: 18.

Chang SS, Smith JA Jr, Wells N, Peterson M, Kovach B, Cookson MS. Estimated blood loss and transfusion requirements of radical cystectomy. J Urol 2001; 166(6): 2151−4.

Masson-Lecomte A, Vordos D, Hoznek A, Yiou R, Allory Y, Abbou CC, et al. External validation of extranodal extension and lymph node density as predictors of survival in node-positive bladder cancer after radical cystectomy. Ann Surg Oncol 2013; 20(4): 1389−94.

Berneking AD, Rosevear HM, Askeland EJ, Newton MR, O'Donnell MA, Brown JA. Morbidity and mortality of octogenarians fol-lowing open radical cystectomy using a standardized reporting system. Can J Urol 2013; 20(4): 6826−31.

Objavljeno
2015/07/08
Broj časopisa
Vol. 72 Br. 2 (2015)
Rubrika
Originalni članak