Robot-assisted Radical Cystectomy for Bladder Cancer in Octogenarians

OBJECTIVES - To evaluate perioperative morbidity and mortality, 3-year recurrence-free survival and cancer-specific mortality in patients older than 80 years undergoing robot-assisted radical cystectomy (RARC).

MATERIALS AND METHODS - We retrospectively collected data of 155 consecutive patients who received RARC for muscle-invasive or high-risk non-muscle invasive urothelial carcinoma of the bladder between 2003 and 2014 at a high-volume robotic center.

Diversion was performed intra- or extracorporeally according to surgeon preferences. Complications were graded according to the Clavien-Dindo system. Logistic regression analyses were used to assess the impact of age on postoperative outcomes.

RESULTS - Of 155 consecutive patients, 22 (14,2%) patients were 80 years or older. Octogenarians did not significantly differ from younger patients in ASA-score (p=0.4) and Charlson comorbidity index (p=0.4). Prevalence of any grade and high-grade complications was similar in both groups (all p≥0.6). Older patients had significantly higher pathological tumor grade (p=0.04) and a lower use of pelvic lymphadenectomy (p<0.001). No perioperative mortality was recorded within 90 days from surgery. Elderly patients had a similar risk of 3-year oncological recurrence after surgery as compared to their younger counterparts (OR 1.63; p=0.2). Conversely, the risk of cancer-specific mortality was significantly higher (OR 2.78; p=0.02).

COCLUSIONS - Patients of eighty years or older undergoing RARC for bladder cancer did not have a higher risk of peri- and post-operative morbidity and mortality and had a similar 3-year recurrence-free survival, suggesting that RARC can be safely performed in selected elderly patients by experienced surgeons.

Journal of endourology / Endourological Society. 2016 Feb 25 [Epub ahead of print]

Ruben De Groote, Giorgio Gandaglia, Nicolas Geurts, Marjin Goossens, Elsabeth Pauwels, Frederiek D'Hondt, Nicola Fossati, Christian Gratzke, Geert De Naeyer, Peter Schatteman, Carpentier Paul, Giacomo Novara, Alex Mottrie

aalst, Belgium ; Via OlgettinaMilan, Italy , 20132 Belgium ;  , aalst, Belgium ;  ., aalst, Belgium ;  ., aalst, Belgium ;  Milan, Italy ;  LMU Munich, Urology , Marchioninistr. 15 , Munich, Germany , 81377 ;   Onze-Lieve-Vrouw Ziekenhuis, Urology , Moorselbaan 164 , Aalst, Belgium , 9300 ;  aalst, Belgium ;  aalst, Belgium ;  University of Padua, Oncological and surgical sciences, Urology Clinic , Monoblocco Ospedaliero - IV Floor Via Giustiniani 2 , Padua, Italy , 35100 ;  Onze Lieve Vrouwziekenhuis, 37467, Aalst, Belgium , 9300 ;  

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