Robotic-assisted laparoscopic radical cystectomy in the octogenarian.
BACKGROUND
The advanced age and comorbidities often associated with bladder cancer patients creates a difficult scenario regarding further management. Robotic-assisted laparoscopic radical cystectomy (RALRC) has had favorable results as a minimally invasive treatment option. We studied perioperative outcomes of RALRC in octogenarians to discern if there is any added benefit in this patient population.


METHODS
One hundred and sixty robotic cystectomies have been performed between October 2003 and June 2010. We identified 24 octogenarians who underwent RALRC and form the cohort of the study.


RESULTS
Mean patient age was 84.7 years and mean BMI was 24 kg/m². Most of the patients in the study had serious medical comorbidities, as 82.6% of them had an ASA classification ≥ 3 and 95.6% had Charlson scores ≥ 3. There was one open conversion and two patients had positive surgical margins. There were a total of 45 complications in the study, with 14 major complications observed in the 90-day period after surgery. There were five patients who had no complications, and two patients expired as a result of multiple organ failure. At 24 months the overall, disease-free and disease-specific survivals were 51.1%, 64.3%, and 79%, respectively. The 90-day mortality rate was 8.7%.


CONCLUSIONS
Octogenarians undergoing RALRC have a significant risk of morbidity and mortality. The relationship between advanced age and oncologic outcomes or complications needs to be discerned further as it relates to the octogenarian. Further study is needed to delineate the safety and efficacy of this approach.
Department of Urology, Division of Urologic Oncology, City of Hope Comprehensive Cancer Center. Cllau@coh.org
Clayton S
CS
Lau
John
J
Talug
Stephen B
SB
Williams
David Y
DY
Josephson
Nora H
NH
Ruel
Kevin G
KG
Chan
Timothy G
TG
Wilson
D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D015653:Cystectomy / Q000295:instrumentation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005853:Geriatrics / Q000379:methods*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D017063:Outcome Assessment, Health Care; D015203:Reproducibility of Results; D012371:Robotics / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000379:methods*; D001743:Urinary Bladder / Q000601:surgery