Introduction:Open radical cystectomy (ORC) or minimally invasive radical cystectomy with pelvic lymph node (LN) dissection carries significant morbidity to the elderly as they often have several medical comorbidities that make a surgical approach more challenging.
The objective of this study is to compare robot-assisted radical cystectomy (RARC) and ORC in elderly patients.
Methods: A prospective bladder cancer cystectomy database was queried to identify all patients age ≥ 75. A total of 20 patients were identified for each of the RARC and ORC cohorts. A retrospective analysis was performed on these 40 patients undergoing radical cystectomy for curative intent.
Results: Patients in both groups had comparable pre-operative characteristics and demographics. Patients had significant medical comorbidities with 80% in each cohort having ASA classification of 3 and 50% having had prior abdominal surgery. Complete median operative times for RARC was 461 (IQR 331, 554) vs. 370 minutes for ORC (IQR 294, 460) (p = 0.056); however, median blood loss for RARC was 275 (IQR 150, 450) vs. 600 mL for ORC (IQR 500, 1925). The median hospital stay for RARC was 7 (IQR 5, 8) vs. 14.5 days for ORC (IQR 8, 22) (p < 0.001). The major complication (Clavien ≥ 3) rate for RARC was 10% compared to 35% for ORC (p = 0.024). There were 2 positive margins in the ORC group compared to 1 in the RARC group with median LN yields of 15 (IQR 11, 22) and 17 nodes (IQR 10, 25) (p = 0.560) respectively.
Conclusions: In a comparable cohort of elderly patients, RARC can achieve similar peri-operative outcomes without compromising pathologic outcomes, with less blood loss, and shorter hospital stays. For an experienced robotic team, RARC should be considered in elderly patients as it may offer significant advantage with respect to peri-operative morbidity over ORC.
Written by:
Richards KA, Kader AK, Otto R, Pettus JA, Smith Iii JJ, Hemal AK. Are you the author?
Wake Forest University Baptist Medical Center, Urology, Winston-Salem, North Carolina, United States.
Reference: J Endourol. 2012 May 14. Epub ahead of print.
doi: 10.1089/end.2012.0035
PubMed Abstract
PMID: 22582706
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