Robotic-assisted radical cystectomy (RARC) for bladder cancer is safe and feasible for octogenarians, investigators concluded.
In a study of 1988 patients aged 80 years or older, Alice Yu, MD, MPH, of H. Lee Moffitt Cancer Center in Tampa, Florida, and colleagues found that the perioperative mortality rate was 2.2% among patients who underwent RARC compared with 4.6% among those who had open surgery. On multivariable analysis, RARC was associated with lower in-hospital mortality compared with open surgery even after controlling for patient and hospital characteristics, Dr Yu’s team reported online ahead of print in Urologic Oncology.
The RARC group also had a significantly shorter hospital length of stay compared with the open surgery group (8 vs 9 days) and had a higher proportion of patients who were discharged home or to self-care (62.3% vs 56.6%). The RARC group, however, had a higher proportion of patients readmitted within 90 days after discharge (42.3% vs 36.5%). The authors noted that the early discharge observed in the RARC group may have contributed to the higher readmission rate in that group. The RARC and open surgery groups had similar rates of major, minor, and overall 90-day complication, according to the investigators.
“The benefits of robotic surgery may have a more pronounced effect in octogenarians and may explain the improved early perioperative outcomes observed in this study,” Dr Yu and colleagues wrote.
The study population included 416 patients who underwent RARC and 1572 who had open surgery. Both groups had a median age of 82 years.
As far as the investigators are aware, their study is the first to examine the role of RARC “in a meaningful sample of octogenarians.”
Yu A, Wang Y, Mossanen M, et al. Robotic-assisted radical cystectomy is associated with lower perioperative mortality in octogenarians. Urol Oncol. Published online September 30, 2021. doi:10.1016/j.urolonc.2021.08.027