Laparoscopy and RoboticsFeasibility and Outcomes of Robotic-assisted Laparoscopic Radical Cystectomy for Bladder Cancer in 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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Cited by (30)
Robotic-assisted radical cystectomy is associated with lower perioperative mortality in octogenarians
2022, Urologic Oncology: Seminars and Original InvestigationsPerioperative and oncological outcomes of robot-assisted radical cystectomy in octogenarians
2020, Journal of Geriatric OncologyThe evolution of robotic surgery: Surgical and anaesthetic aspects
2017, British Journal of AnaesthesiaCitation Excerpt :This may be as a result of reduced blood loss and transfusion rates, alongside reduced wound and fascial complications despite longer operating times.62 Interestingly several studies across a variety of surgical specialities have found there to be no differences in outcomes between younger and older patient groups having robotic surgery,63–65 indicating age alone is not a risk factor. One study demonstrated that older patients having robotic surgery vs younger patients having open surgery had significantly lower early complication rates (17% vs 59%).52
Radical cystectomy in the elderly – Is this a safe treatment option?
2017, Arab Journal of UrologyCitation Excerpt :Another cited reason for not offering radical surgery to elderly patients is the supposedly increased risk of perioperative complications. RC is a major procedure that is associated with a high complication rate, ranging from 34% to 65% [2,4,9,10,23]. Our present data are comparable with published results, with an overall complication rate of 60%, of which 86% were classified as Clavien–Dindo Grade I–II (i.e. minor).
Laparo-endoscopic single-site radical cystectomy with orthotopic urinary diversion: Technique, feasibility, and the 3-year follow-up
2014, Arab Journal of UrologyCitation Excerpt :Laparoscopic and robotic RC have been developed as a minimally invasive alternative to open RC in an attempt to reduce its perioperative morbidity. Comparative studies between laparoscopic, robotic and the open approach have shown an improved overall morbidity in favour of those minimally invasive approaches, in terms of decreased blood loss, shorter hospital stay, and rapid convalescence [2–4]. In both laparoscopic and robotic RC the procedure requires five or six ports for the RC.
Robotic assisted laparoscopic radical cystectomy for bladder carcinoma: Early experience and oncologic outcomes
2012, Formosan Journal of Surgery