Feasibility of robot-assisted radical prostatectomy in high elderly patients: Comparative analysis of the perisurgical/oncological outcomes with younger patients.

Abstract

120 Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in high elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical / oncological outcomes for younger and elder patients underwent RARP. Methods: We reviewed and compared our 553 consecutive patients who underwent RARP in 3 institutes from 6/2013 to 2/2018 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 75 and over 75 years. Results: In our cohort, 477 men were age less than 75 and 76 men were ≥75. Preoperative parameters (PSA, T factor) were similar in both younger and high elder groups. But Gleason score was higher in elder group than younger group ( p=0.009). Operative time (median: 232 vs. 212 minutes) and estimated blood loss (median 100 ml vs 100 ml) were similar in both groups. Two of elder patients (3.8%) needed transfusion. Peri/post-operative all grade complications were 1.4%/6.5% in younger group and 3.8%/9.6% in elder group. No case needed intra-operative open conversion. Surgical positive margin rates were also similar (29.5%, younger vs. 23.7%, elder). Both younger patients (93.6%) and elder patients (90.3%) recovered their continence at 12 months. After a median follow-up of 33.0 months, the 3-year PSA-free survival rates were 86.0% for elder patients and 88.9% for younger patients (p>0.05). Conclusions: In our study, RARP in high elderly patients was relatively safe surgical procedure with a limited complication rate, excellent oncologic and continence outcomes. RARP is feasible even in elderly patients.