Robotic Cystectomy May Be Better Option for Elderly Patients

Robot-assisted radical cystectomy (RARC) may provide advantages over open cystectomy for patients aged 70 years and older who have muscle-invasive bladder cancer, study findings suggest.

In a study comparing 58 patients who underwent RARC and 84 who underwent open cystectomy, investigators at the University of Alabama-Birmingham, found that RARC was associated with better perioperative outcomes and equivalent oncologic parameters. The mean operative time was significantly longer in the RARC than the open cystectomy group (7.8 vs. 6.6 hours), but mean estimated blood loss was significantly less in the RARC group (276 vs. 1,522 mL), researchers led by Rizk El-Galley, MD, reported online ahead of print in the Journal of Endourology. Significantly more patients in the open cystectomy group than the RARC group require blood transfusion (80% vs. 5.2%).

The study found no significant difference between the groups in positive margin rate, mean lymph node yield, and percentage of positive lymph nodes.

Early complications of any severity occurred in 43% of RARC patients compared with 64% in the open cystectomy group, Dr. El-Galley's group reported. When the investigators divided patients into those younger than 70 and those aged 70 and older, they found that the older patients in the RARC group had a significantly lower rate of early complications within 30 days of surgery than the younger patients in the open cystectomy group (17% vs. 59%).

“This is a significant finding given the increasing elderly population, and the fact that urothelial carcinoma occurs more frequently in this population,” the authors wrote.

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