You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2018MP47-13 ROBOT-ASSISTED RADICAL CYSTECTOMY IN OCTOGENARIANS AND THE EFFECT OF AN ENHANCED RECOVERY PATHWAY ON PERI-OPERATIVE INDICES Avinash Chenam, Justin Emtage, Nora Ruel, Patrick Kilday, Juzar Jamnagerwalla, Clayton Lau, Jonathan Yamzon, Ali Zhumkhawala, Bertram Yuh, and Kevin Chan Avinash ChenamAvinash Chenam More articles by this author , Justin EmtageJustin Emtage More articles by this author , Nora RuelNora Ruel More articles by this author , Patrick KildayPatrick Kilday More articles by this author , Juzar JamnagerwallaJuzar Jamnagerwalla More articles by this author , Clayton LauClayton Lau More articles by this author , Jonathan YamzonJonathan Yamzon More articles by this author , Ali ZhumkhawalaAli Zhumkhawala More articles by this author , Bertram YuhBertram Yuh More articles by this author , and Kevin ChanKevin Chan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1492AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The management of aggressive bladder cancer poses a unique challenge due to the often-advanced age at diagnosis. This is becoming more common with the increasing longevity of the general population and incidence of bladder cancer as a whole. Robot-assistance may offer decreased peri-operative morbidity in comparison to open surgery, especially important in the elderly. Further, enhanced recovery protocols can offer added benefits on operative outcomes in this population. Thus, we present our experience with robot-assisted radical cystectomy in a strictly octogenarian population and the effect of the City of Hope Cystectomy Pathway on peri-operative indices. METHODS We identified all patients who were >80 years at the time of their robot-assisted radical cystectomy performed at our institution between October 2003 to present. Demographic and peri-operative data were collected in an IRB-approved database. Patients were then stratified by whether or not they were subject to the City of Hope Cystectomy Pathway that was instituted in April 2014 and these cohorts were compared. RESULTS A total of 87 octogenarians underwent robot-assisted radical cystectomy during our study period. 20 of these were subject to the pathway. The total mean age was 83.9 years, and the vast majority were unhealthy with 91.9% of the cohort having an ASA score of 3 or higher. Most patients (85.1%) underwent ileal conduit diversions. Median estimated blood loss was 250 cc. 63.2% of patients required blood transfusions. There were 3 (3.4%) open conversions. Median length of stay was 10 days. 31.0% of patients experienced major complications at 90 days. The 30 and 90-day mortality rate was 3.4% and 12.6%, respectively. The 30 and 90-day readmission rate was 32.2% and 42.5%, respectively. Pathway patients had a higher ASA and lower estimated blood loss. Use of the pathway reduced length of stay by 3 days. There was no difference observed in the rate of complications, peri-operative mortality or early readmission. CONCLUSIONS Robot-assisted radical cystectomy is safe and feasible in octogenarians with an acceptable peri-operative morbidity profile that can potentially be an improvement when compared to open surgery. The City of Hope cystectomy pathway was not associated with a reduction in the rates of early complications, mortality or readmissions but a shorter length of stay was observed. Larger randomized, prospective trials are needed to further investigate our findings. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e620-e621 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Avinash Chenam More articles by this author Justin Emtage More articles by this author Nora Ruel More articles by this author Patrick Kilday More articles by this author Juzar Jamnagerwalla More articles by this author Clayton Lau More articles by this author Jonathan Yamzon More articles by this author Ali Zhumkhawala More articles by this author Bertram Yuh More articles by this author Kevin Chan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...