膀胱全摘除術を推奨する立場から

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過去10年間に膀胱癌と診断され,根治的膀胱全摘除術を受けた43例を,40～64歳(12例),65～69歳(12例),70～74歳(12例),75歳以上(7例)の4群に分け,治療成績を臨床的に比較検討した.1)術前合併症は高血圧,糖尿病,冠動脈疾患,不整脈が多く,70歳を過ぎると増加傾向がみられたが,各群間に有意差はなかった.2)2つ以上の合併症を有する割合は,加齢とともに増加する傾向がみられた.高齢者では他の3群よりも出血量,輸血量が有意に多かった.3)術後合併症の発生には有意差はなかったが,術後死亡は75歳以上群で多臓器不全を合併した1例であった.術後補助療法は75歳以上群には1例しか施行されていなかった.4)癌死は75歳以上群ではみられなかったが,他因死は3例であった.75歳以上群の3年生存率は100%であった.したがって高齢者に根治手術を行うかの最終的な決定は患者の医学的評価に基づいて判定されるべきであり,歴年齢のみによって決定すべきではないと考えられたBetween 1995 and 2004, 43 patients underwent radical cystectomy and urinary diversion for the treatment of invasive bladder cancer at our institution. Of these patients, seven who were 75 years old or older, were considered elderly. Survival and treatment outcome of these patients were compared to younger counterparts stratified into three groups by age at diagnosis (12 patients younger than 64, 12 patients 65 to 69 years, and 12 patients 70 to 74 years). Preoperative morbidity was encountered in 57% of the elderly patients, and 42% of the elderly patients had two or more complications. There was one operative death (14%) among the elderly patients but no such deaths in the 3 younger groups. The postoperative complication rate for patients age 75 years or older was 86%, compared to 75% for patients younger than 64, 75% for those age 65 to 69 and 83% for those age 70-74. The prevalence did not differ significantly between the older and youger patients. There were no cancer deaths among the elderly patients, but 8 of the 36 younger patients died of cancer. The cancer-specific 5-year survival rate was 100% at 34 months in the elderly population. These findings suggest that radical cystectomy and urinary diversion is a relatively safe procedure and a curative operation is worth attempting in elderly patients with invasive bladder cancer, if they are in generally good health.
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膀胱全摘除術を推奨する立場から

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