title: Feasibility and outcomes of robotic-assisted laparoscopic radical cystectomy for bladder cancer in older patients.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Urologic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7235, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Coward
authors.forename: Angela
authors.initials: A
authors.lastname: Smith
authors.forename: Mathew
authors.initials: M
authors.lastname: Raynor
authors.forename: Matthew
authors.initials: M
authors.lastname: Nielsen
authors.forename: Eric M
authors.initials: EM
authors.lastname: Wallen
authors.forename: Raj S
authors.initials: RS
authors.lastname: Pruthi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*