Abstract：
OBJECTIVE: To evaluate the safety and efficacy of robot-assisted radical cystectomy using an intracorporeal ileal conduit in older compared to younger patients.
METHODS: We retrospectively analyzed 122 patients who underwent robot-assisted radical cystectomy with an intracorporeal ileal conduit at Fujita Health University Hospital and Fujita Health University Okazaki Medical Center between 2012 and 2022. Patients were categorized into two groups: older (age ≥ 75 years; n = 53) and younger (age < 75 years; n = 69). Perioperative outcomes, complications, recurrence-free survival, cancer-specific survival, and overall survival were compared between the cohorts.
RESULTS: The groups had no significant differences in perioperative outcomes, such as estimated blood loss, operative time, and blood transfusion rate. However, hospital stay was longer in the older patients than in the younger group (19 vs. 16 days; p < 0.001). The 30-day minor and major complication rates were 33.3% and 13.0%, respectively, for the younger group and 50.9% and 9.4% for the older group (p = 0.11). Urinary tract infection and bowel ileus were the most common complications in both groups. No significant differences were observed in recurrence-free survival, cancer-specific survival, and overall survival between the groups (p = 0.58, p = 0.75, and p = 0.78), and subgroup analysis in ≥cT3 revealed the older group tended to have poorer cancer-specific survival and overall survival (p = 0.07 and p = 0.01). Multivariate analysis indicated that older age was not associated with high-grade complications and cancer-specific survival.
CONCLUSIONS: Robot-assisted radical cystectomy with an intracorporeal ileal conduit is a safe and effective treatment option for older patients.
METHODS: We retrospectively analyzed 122 patients who underwent robot-assisted radical cystectomy with an intracorporeal ileal conduit at Fujita Health University Hospital and Fujita Health University Okazaki Medical Center between 2012 and 2022. Patients were categorized into two groups: older (age ≥ 75 years; n = 53) and younger (age < 75 years; n = 69). Perioperative outcomes, complications, recurrence-free survival, cancer-specific survival, and overall survival were compared between the cohorts.
RESULTS: The groups had no significant differences in perioperative outcomes, such as estimated blood loss, operative time, and blood transfusion rate. However, hospital stay was longer in the older patients than in the younger group (19 vs. 16 days; p < 0.001). The 30-day minor and major complication rates were 33.3% and 13.0%, respectively, for the younger group and 50.9% and 9.4% for the older group (p = 0.11). Urinary tract infection and bowel ileus were the most common complications in both groups. No significant differences were observed in recurrence-free survival, cancer-specific survival, and overall survival between the groups (p = 0.58, p = 0.75, and p = 0.78), and subgroup analysis in ≥cT3 revealed the older group tended to have poorer cancer-specific survival and overall survival (p = 0.07 and p = 0.01). Multivariate analysis indicated that older age was not associated with high-grade complications and cancer-specific survival.
CONCLUSIONS: Robot-assisted radical cystectomy with an intracorporeal ileal conduit is a safe and effective treatment option for older patients.
摘要：
目的：评估使用体内回肠导管的机器人辅助根治性膀胱切除术在老年患者和年轻患者中的安全性和有效性。
方法：我们回顾性分析了2012年至2022年在藤田健康大学医院和藤田健康大学冈崎医学中心接受机器人辅助根治性膀胱切除术的122例患者。患者分为两组：年龄较大（年龄≥75岁；n=53）和年龄较小（年龄<75岁；n=69）。围手术期结果,并发症,无复发生存率,癌症特异性生存率，和总生存率在队列之间进行比较.
结果：两组患者围手术期结局无显著差异，比如估计的失血量,手术时间,输血率。然而,老年患者的住院时间比年轻组的住院时间长(19vs.16天；p<0.001）。30天轻微和主要并发症发生率分别为33.3%和13.0%，分别,年轻组的50.9%和老年组的9.4%(p=0.11)。尿路感染和肠梗阻是两组最常见的并发症。无复发生存率无显著差异，癌症特异性生存率，和组间总生存率（p=0.58，p=0.75和p=0.78），≥cT3的亚组分析显示,老年组的癌症特异性生存率和总生存率更差(p=0.07和p=0.01).多因素分析表明，年龄与高级别并发症和癌症特异性生存率无关。
结论：对于老年患者，机器人辅助下的根治性膀胱切除术和回肠导管是一种安全有效的治疗选择。
方法：我们回顾性分析了2012年至2022年在藤田健康大学医院和藤田健康大学冈崎医学中心接受机器人辅助根治性膀胱切除术的122例患者。患者分为两组：年龄较大（年龄≥75岁；n=53）和年龄较小（年龄<75岁；n=69）。围手术期结果,并发症,无复发生存率,癌症特异性生存率，和总生存率在队列之间进行比较.
结果：两组患者围手术期结局无显著差异，比如估计的失血量,手术时间,输血率。然而,老年患者的住院时间比年轻组的住院时间长(19vs.16天；p<0.001）。30天轻微和主要并发症发生率分别为33.3%和13.0%，分别,年轻组的50.9%和老年组的9.4%(p=0.11)。尿路感染和肠梗阻是两组最常见的并发症。无复发生存率无显著差异，癌症特异性生存率，和组间总生存率（p=0.58，p=0.75和p=0.78），≥cT3的亚组分析显示,老年组的癌症特异性生存率和总生存率更差(p=0.07和p=0.01).多因素分析表明，年龄与高级别并发症和癌症特异性生存率无关。
结论：对于老年患者，机器人辅助下的根治性膀胱切除术和回肠导管是一种安全有效的治疗选择。
