Elsevier

Urology

Volume 77, Issue 5, May 2011, Pages 1111-1114
Urology

Laparoscopy and Robotics
Feasibility and Outcomes of Robotic-assisted Laparoscopic Radical Cystectomy for Bladder Cancer in Older Patients

https://doi.org/10.1016/j.urology.2010.07.510Get rights and content

Objectives

To report our maturing experience with robotic radical cystectomy as applied to an older patient population with regard to perioperative measures and pathologic outcomes. A robotic approach to radical cystectomy for bladder cancer have recently been described, but its application in an older patient population, which is often the case in bladder cancer and cystectomy, has not yet been assessed.

Methods

A total of 119 patients underwent robotic cystectomy and extracorporeal urinary diversion at our institution from January 2006 through October 2009 for clinically localized bladder cancer. Owing to the patient selection early in the present series, the first 20 cases were excluded. The clinical characteristics, operative outcomes, and pathologic results of the consecutive cases were categorized by age (younger, <70 years vs older, age ≥70 years).

Results

The outcomes of the 61 younger and 38 older patients, including 7 patients >80 years old, were assessed. The younger versus older patients had a lower American Society of Anesthesiologists score (2.6 vs 3.0; P < .001), greater body mass index (28.2 vs 26.1; P = .008), and longer operating room time (4.8 vs 4.4 hours; P = .015). No differences were observed between the 2 groups in blood loss, time to discharge, or complication rate. Also, no significant differences were found in the surgical pathologic findings, including the organ-confined rate (62% vs 71%) and lymph node yield (19.5 vs 18.1).

Conclusions

Older patients do not appear to have any significant differences or compromises with regard to the perioperative and pathologic outcomes after robotic radical cystectomy. Thus, robotic radical cystectomy appears to be an appropriate surgical option for older patients.

Section snippets

Material and Methods

In accordance with the principles and practices of the University of North Carolina institutional review board and in recognition of, and compliance with, the U.S. Health Insurance Portability and Accountability Act of 1996, a retrospective review was performed of our bladder cancer database. We identified 119 patients who had undergone robotic cystectomy and extracorporeal urinary diversion at our institution from January 2006 through October 2009 for clinically localized urothelial bladder

Results

The mean age of the present study cohort was 65.7 years (range 33-86). Of the 99 patients, 61 were included in the younger group (age <70 years) and 38 patients in the older group (age ≥70 years), including 7 patients >80 years old. The results, categorized by age, are summarized in Table 1. Significant differences between the 2 cohorts were observed in BMI, ASA score, operative time, and diversion type (Table 2). For the younger versus older patients, the BMI was greater (28.2 vs 26.1 kg/m2; P

Comment

The data we have presented support the premise that a robotic approach to radical cystectomy can be safely offered to carefully selected older patients. With the aging population and increasing incidence of bladder cancer, our treatments must be continually applied to an older patient population, even when the treatment involves radical surgery. Age has been shown to contribute to the treatment decisions for patients with muscle-invasive disease. In a recent retrospective study of 820 patients

Conclusions

In our evolving experience with robotic-assisted radical cystectomy, older patients did not appear to have any significant differences or compromises with regard to the perioperative and pathologic outcomes. As such, robotic-assisted laparoscopic radical cystectomy appears to be an appropriate surgical option for carefully selected older patients. The robotic technique is still in an early period of evaluation, and long-term evaluations—especially oncologic outcomes—are ultimately required for

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