title: Perioperative and continence outcomes of robotic radical prostatectomy in elderly Indian men (≥70 years): A sub-group analysis.
abstract: BACKGROUND
  Many healthy elderly Indian men seek surgical treatment for localized prostate cancer. Quite often, radical surgery is not offered to the patients over 70 years of age due to the perception of increased side-effects and complications. We have previously reported our results of robotic radical prostatectomy in a study comprising 150 Indian patients, where almost a quarter of patients were elderly. This subgroup analysis was therefore focused on evaluating perioperative and continence outcomes in elderly men (≥70 years) with localized prostate cancer.
  
  
  METHODS
  Between April 2010 and August 2013, 153 men had robot-assisted radical prostatectomy performed by two surgeons. Of the 150 men analyzed, 39 (26%) were aged ≥70 years. All patients underwent robotic prostatectomy using a 4 arm da Vinci surgical system. Pre-operative, intraoperative and post-operative parameters were studied. Check cystogram was performed in all patients prior to catheter removal. Complications were categorized using the Clavien-Dindo classification system. Continence was defined as use of "no pad" or security liner only. All data were recorded prospectively and analyzed using SPSS version 20.
  
  
  RESULTS
  There were no significant intraoperative or perioperative complications in this group. Median blood loss during surgery was 150 mL. None of the patient required blood transfusion. There were two minor complications (5.1%) within the first 30 days of surgery: Minimal anastomotic site leak (one patient) requiring replacement and prolongation of Foley's drainage by 1 week and ileus (one patient). No patient had any cardiopulmonary or vascular complications in the post-operative period. The median duration of hospital stay was 3 days. The median duration of catheterization was 7 days. No patient had problem of bladder neck stenosis in the follow-up period. At 1 month, 3 months, 6 months and 1 year of follow-up, 66.7% (n = 26), 74.3% (n = 29), 87.9% (n = 34) and 94.8% (n = 37), respectively, were continent.
  
  
  CONCLUSIONS
  Robotic surgery is safe and feasible in a select group of elderly patients. It has acceptable and minimal perioperative complications along with good continence outcome.
authors.affiliation: Department of Urology, Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Delhi, NCR, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Yadav
authors.affiliation: Department of Urology, Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Delhi, NCR, India.
authors.forename: Narmada P
authors.initials: NP
authors.lastname: Gupta
authors.affiliation: Department of Urology, Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Delhi, NCR, India.
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Akpo
authors.affiliation: Department of Urology, Institute of Kidney and Urology, Medanta-The Medicity, Gurgaon, Delhi, NCR, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Kumar
keywords: Continence; elderly men; prostate cancer; robotic prostatectomy; robotic surgery