BACKGROUND AND PURPOSE: 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. PATIENTS AND METHODS: After Institutional Review Board 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, American Society of Anesthesiologists score (ASA), Charlson Comorbidity Index, pathologic stage, estimated blood loss, transfusion rate, and 90-day morbidity and mortality rate. RESULTS: Twenty-three patients over the age of 80 years 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 208 mL (range 50-650 mL) and 253 minutes (range 175-365 min). Seven (30.4%) patients needed blood transfusions. 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. The 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.
BACKGROUND AND PURPOSE: 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. PATIENTS AND METHODS: After Institutional Review Board 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, American Society of Anesthesiologists score (ASA), Charlson Comorbidity Index, pathologic stage, estimated blood loss, transfusion rate, and 90-day morbidity and mortality rate. RESULTS: Twenty-three patients over the age of 80 years 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 208 mL (range 50-650 mL) and 253 minutes (range 175-365 min). Seven (30.4%) patients needed blood transfusions. 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. The 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.
Authors: Karthik Tanneru; Seyed Behzad Jazayeri; Jatinder Kumar; Muhammad Umar Alam; Daniel Norez; Sabine Nguyen; Soroush Bazargani; Hariharan Palayapalayam Ganapathi; Mark Bandyk; Robert Marino; Shahriar Koochekpour; Shiva Gautam; K C Balaji; Joseph Costa Journal: J Robot Surg Date: 2020-11-22
Authors: Bernard H Bochner; Guido Dalbagni; Karim H Marzouk; Daniel D Sjoberg; Justin Lee; Sheri M Donat; Jonathan A Coleman; Andrew Vickers; Harry W Herr; Vincent P Laudone Journal: Eur Urol Date: 2018-05-18 Impact factor: 20.096
Authors: Daniel P Nguyen; Bashir Al Hussein Al Awamlh; E Charles Osterberg; James Chrystal; Thomas Flynn; Daniel J Lee; Douglas S Scherr Journal: World J Urol Date: 2014-11-20 Impact factor: 4.226
Authors: Ashkan Mortezavi; Alessio Crippa; Sebastian Edeling; Sasa Pokupic; Paolo Dell'Oglio; Francesco Montorsi; Frederiek D'Hondt; Alexandre Mottrie; Karel Decaestecker; Carl J Wijburg; Justin Collins; John D Kelly; Wei Shen Tan; Ashwin Sridhar; Hubert John; Abdullah Erdem Canda; Christian Schwentner; Erik Peder Rönmark; Peter Wiklund; Abolfazl Hosseini Journal: BJU Int Date: 2020-11-05 Impact factor: 5.588