Jian-Hui Lin

Performing laparoscopic radical cystectomy is feasible for the elderly with marginal cardiopulmonary function

Purpose: The purpose of this study was to report the feasibility, safety, and benefits of laparoscopic radical cystectomy (LRC) for patients with bladder cancer (BC) who are older than 75 years and with marginal cardiopulmonary function in a regional teaching hospital. Materials and Methods: The charts of thirty patients who underwent LRC between 2013 and 2016 in a community teaching hospital were reviewed. The patients were subgrouped into the age groups ≥75 years and <75 years. Data extracted from the charts included patient demographics, American Society of Anesthesiologists (ASA) Score, Charlson Comorbidity Index (CCI) Score, cardiopulmonary function test result, pathological results, conversion rate, operative time, Intensive Care Unit days, and postoperative recovery time. Results: A significant difference was observed in the data of the group ≥75 years group compared with the <75 years group, with a higher ASA score (P = 0.0007) and higher rate of marginal cardiopulmonary function (80% vs. 26.7%, P = 0.0092). No significant difference was observed in sex, CCI score (3.93 vs. 3.27), body mass index (24.8 vs. 24.4), ejection fraction (69% vs. 70.97%), operation time (473 vs. 465 min), blood loss (503 vs. 380 mL), urinary diversion type, Intensive Care Unit care (1.13 vs. 0.6 days), interval to ambulation (2 vs. 1.8 days), interval to oral food intake (3.2 vs. 2.6 days), interval to normal bowel function (4.6 vs. 3.6 days), postoperative hospitalization (15.67 vs. 11.67 days), and blood transfusion rate (33.3% vs. 26.7%) between the two groups. No conversion to open surgery or mortality was observed. Surgical complications occurred in 15 patients, with a complication rate of 50%. No surgical mortality was noted in 30 or 90 days. Most pathological cases revealed urothelial carcinoma. Conclusions: LRC is a safe option with favorable outcomes in BC patients older than 75 years with marginal cardiopulmonary function in a regional teaching hospital.