INTRODUCTION: Radical cystectomy is the standard of care for muscle-invasive bladder cancer; however, few patients over age 75 undergo cystectomy.
Morbidity and mortality rates in this age group approach 60% and 10% respectively. We sought to determine if minimally invasive surgery, in the form of robot-assisted radical cystectomy (RARC) may reduce morbidity and mortality associated with this operation in elderly patients.
METHODS: After IRB approval, all RARC performed between 2009 and 2012 from one institution were reviewed and 23 cases in patients over the age of 80 were identified. Data analyzed included age, indication for cystectomy, ASA score, Charlson comorbidity index, pathologic stage, EBL, transfusion rate, and 90-day morbidity and mortality rate.
RESULTS: 23 patients over the age of 80 underwent RARC by a single surgeon (IT) between April 2009 and October 2012. Average age was 83.7 years (range 80-88 years) with average Charlson comorbidity index score of 4.3 (age-weighted 8.3). Indication for cystectomy was oncologic in all cases (21 bladder malignancy, 2 hemorrhagic cystitis in the setting of prostate cancer). The average blood loss and operative times were 208mL (range 50-650mL) and 253 minutes (range 175-365 minutes). Seven patients required blood transfusions (30.4%). The average length of hospital stay was 8.2 days (range 6-24 days). The overall complication rate within 90 days was 34.8% (8 patients) with no mortality. Longest follow up is 34 months.
CONCLUSIONS: RARC should be strongly considered for patients over the age of 80 with clinical indications for cystectomy. Complication rate is acceptable even in complicated patients with multiple comorbidities and those with previous abdominal surgery or pelvic radiation. Hospital stay remains shorter than with open surgery, and complication rates appear to be lower than previously reported for this age group.
Written by:
Phillips E, Uberoi V, Tuerk I. Are you the author?
Boston Medical Center, Urology, Boston, Massachusetts, United States.
Reference: J Endourol. 2013 Sep 27. Epub ahead of print.
doi: 10.1089/end.2013.0159
PubMed Abstract
PMID: 24074288
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