title: Robot-Assisted Radical Cystectomy for Bladder Cancer in Octogenarians.
abstract: To evaluate perioperative morbidity and mortality rate, a 3-year recurrence-free survival, and cancer-specific mortality rate in patients older than 80 years undergoing robot-assisted radical cystectomy (RARC).
  
  
  
  We retrospectively collected data of 155 consecutive patients who received RARC for muscle-invasive or high-risk nonmuscle-invasive urothelial carcinoma of the bladder between 2003 and 2014 at a high-volume robotic center. Diversion was performed intra- or extracorporeally according to the surgeon's preferences. Complications were graded according to the Clavien-Dindo system. Logistic regression analyses were used to assess the impact of age on postoperative outcomes.
  
  
  
  Of 155 consecutive patients, 22 (14.2%) patients were 80 years or older. Octogenarians did not significantly differ from younger patients in ASA score (p = 0.4) and Charlson comorbidity index (p = 0.4). Prevalence of any grade and high-grade complications was similar in both groups (all p ≥ 0.6). Older patients had a significantly higher pathologic tumor grade (p = 0.04) and a lower use of pelvic lymphadenectomy (p < 0.001). No perioperative mortality rate was recorded within 90 days from surgery. Elderly patients had a similar risk of 3-year oncologic recurrence after surgery compared with their younger counterparts (odds ratio [OR] 1.63; p = 0.2). Conversely, the risk of cancer-specific mortality rate was significantly higher (OR 2.78; p = 0.02).
  
  
  
  Patients 80 years or older undergoing RARC for bladder cancer did not have a higher risk of peri- and postoperative morbidity and mortality rate and had a similar 3-year recurrence-free survival, suggesting that RARC can be safely performed in selected elderly patients by experienced surgeons.
authors.affiliation: 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .
authors.forename: Ruben
authors.initials: R
authors.lastname: De Groote
authors.affiliation: 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .|2 O.L.V. Vattikuti Robotic Surgery Institute , Melle, Belgium .|3 Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele , Milan, Italy .
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .
authors.forename: Nicolas
authors.initials: N
authors.lastname: Geurts
authors.affiliation: 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .
authors.forename: Marijn
authors.initials: M
authors.lastname: Goossens
authors.affiliation: 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Pauwels
authors.affiliation: 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .
authors.forename: Frederiek
authors.initials: F
authors.lastname: D'Hondt
authors.affiliation: 4 Urologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians Universität München , Munich, Germany .
authors.forename: Christian
authors.initials: C
authors.lastname: Gratzke
authors.affiliation: 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .|2 O.L.V. Vattikuti Robotic Surgery Institute , Melle, Belgium .|3 Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele , Milan, Italy .
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.affiliation: 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .
authors.forename: Geert
authors.initials: G
authors.lastname: De Naeyer
authors.affiliation: 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .
authors.forename: Peter
authors.initials: P
authors.lastname: Schatteman
authors.affiliation: 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .
authors.forename: Paul
authors.initials: P
authors.lastname: Carpentier
authors.affiliation: 2 O.L.V. Vattikuti Robotic Surgery Institute , Melle, Belgium .|5 Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua , Padua, Italy .
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.affiliation: 1 Department of Urology, O.L.V. Hospital , Aalst, Belgium .|2 O.L.V. Vattikuti Robotic Surgery Institute , Melle, Belgium .
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mottrie
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D016017:Odds Ratio; D010388:Pelvis; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*