Abstract
BackgroundRadical cystectomy (RC) is the standard treatment for bladder cancer, but the safety and efficacy of this treatment for elderly people need to be considered. We compare perioperative data and survival outcomes between elderly (≥80 years) and younger (<80 years) patients undergoing robot-assisted radical cystectomy (RARC).MethodsWe reviewed demographic, perioperative clinical and follow-up data of 190 consecutive patients with urothelial carcinoma of bladder who received RARC from May 2015 to December 2018 in Nanjing Drum Tower Hospital. The patients were divided into 2 groups by age: ≥80 years and <80 years. Perioperative outcomes were compared between 2 groups. Logistic regression method was used to analyze the factors that may affect preoperative complications. Cox regression model was employed to analyze the factors affecting 3-year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS).ResultsOf the 190 patients, 44 (23.2%) were octogenarians. The elderly patients did not statistically differ from younger patients in most of the demographic, perioperative, and pathological information. American Society of Anesthesiologists (ASA) score (p=0.045) and Charlson comorbidity index (CCI) (p=0.035) could predict high-grade and any grade complications, respectively. Positive lymph node and pT≥3 were main factors affecting OS, RFS, and CSS. ASA score (p=0.048) and CCI (p=0.003) could predict OS and RFS, respectively. Elderly group had worse OS (p=0.007) and CSS (p=0.027) but similar RFS (p=0.147) compared with younger group.ConclusionThe elderly who received RARC had similar risk of perioperative complications and RFS compared with younger patients. RARC could be an alternative treatment for selected octogenarians.
Highlights
Bladder cancer (BCa) is the second most common urinary tract malignancy
With the aggravating trend of aging population throughout the world, we could predict that the number of elderly patients with bladder cancer will be further increasing in the future
The aim of our study is to report the perioperative and short-term oncological outcomes of robot-assisted radical cystectomy (RARC) in elderly BCa patients, and to compare these data with the outcomes observed in younger patients
Summary
Bladder cancer (BCa) is the second most common urinary tract malignancy. In 2018, there were 549, 393 new cases and 199, 922 deaths of bladder cancer around the world [1]. Radical cystectomy (RC) and pelvic lymph node dissection is the standard of care for the treatment of localized MIBC and high-risk NMIBC [3]. Laparoscopic and robotic-assisted laparoscopic surgeries have been more and more applied to the treatment of bladder cancer [7]. These minimally invasive methods may promote postoperative recovery and reduce the incidence of perioperative complications without sacrificing oncologic outcome [8]. We compare perioperative data and survival outcomes between elderly (≥80 years) and younger (
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