高齢者に対する根治的膀胱摘除および尿路変向術後の早期合併症の検討

Abstract

著者らの施設で膀胱癌と診断され, 根治的膀胱摘除および尿路変向術が施行された75歳以上の高齢者26例(高齢摘除群)を対象に, その術後の早期合併症発生率について, 同手術を行なった75歳未満の170例(非高齢群)と比較検討した。1)術後早期合併症の発生率は高齢摘除群で34%, 非高齢群で16%と有意差を認めず, 手術時間・出血量も両群間で大差なかった。2)遠隔転移を有する症例を除いた高齢摘除群, 高齢非摘除群各24例における全生存率を観察期間中央値11.5ヵ月で検討すると, 全生存率は高齢全摘除術で有意に良好であった。3)高齢摘除群は高齢非摘除群に比べ, PSとASAスコアが有意に良好で, 術前に虚血性心疾患, 血管疾患, 精神疾患などを合併している症例が少ない傾向にあった。以上, これらの結果より, 高齢膀胱癌患者における根治的摘除は, PS・ASAスコアの良い適切な症例を選択すれば安全に施行可能であると考えられた。

Clinical and operative features and early postoperative complications were reviewed in 26 patients 75 years old and older who were treated with radical cystectomy including pelvic lymphadenectomy and urinary diversion in our hospital from 1994 to 2005. These findings were compared with those in 170 patients younger than 75 years old who received the same surgery and in 26 patients 75 years old and older who were not surgically treated. Early postoperative complications were found in 9 elderly patients (34%), but there were no deaths in the preoperative and early postoperative periods. There was no significant difference in the rate of early postoperative complications between patients 75 years old and older and those younger than 75. Preoperative performance status (PS) and the American Society of Anesthesiologists Score (ASA score) were significantly better in elderly patients with the surgery than those without surgery. Therefore, evaluation with PS and the ASA score may allow urologists to appropriately select elderly candidates for radical cystectomy and urinary diversion. Chronological age alone is not a determinant for indicating the surgery.