To determine the peri-operative safety and oncological value of robotic-assisted radical cystectomy (RARC) for older and younger patients in an initial Japanese RARC series.
We retrospectively analyzed the demographics, complications, peri-operative and oncological outcomes of 253 consecutive patients with bladder cancer who underwent RARC at 34 institutions in Japan between April 2009 and March 2017. The patients were assigned to groups according to ages at surgery of < 70 (younger; n = 125) and ≥ 70 (older; n = 128) years.
Mean Charlson comorbidity index (p = 0.045) and the incidence of a history of previous abdominal surgery (p = 0.002) were significantly higher, whereas a history of neoadjuvant chemotherapy (p = 0.028) and neobladder (p < 0.001) were significantly lower in the older group. Mean total operative time was significantly shorter (p = 0.019) and mean estimated blood loss (p = 0.013) was significantly lower in the older group. Post-operative Grade ≥ II complications were comparable at 0-30, 31-90 and 91 days after surgery despite urinary tract associations. Rates of positive surgical margins and mean numbers of removed lymph nodes were comparable between the two groups. Although 5-year overall survival rates were significantly lower (p = 0.03) for older patients, 5-year cancer-specific (p = 0.10) and recurrence-free survival rates were comparable (p = 0.20) between the groups.
Using RARC potentially allows the application of less invasive procedures and cancer control for septuagenarian patients that are equivalent to those for younger patients.
International journal of clinical oncology. 2019 May 23 [Epub ahead of print]
Hideto Iwamoto, Shuichi Morizane, Takuya Koie, Ryoichi Shiroki, Mutsushi Kawakita, Tatsuo Gondo, Kazumasa Matsumoto, Tomonori Habuchi, Hiroshi Sunada, Yusuke Endo, Hisashi Noma, Atsushi Takenaka, Hiroomi Kanayama
Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 86 Nishi-cho, Yonago, Tottori, 683-8504, Japan. ., Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 86 Nishi-cho, Yonago, Tottori, 683-8504, Japan., Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Department of Urology, Fujita Health University, Toyoake, Japan., Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan., Department of Urology, Tokyo Medical University, Tokyo, Japan., Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan., Department of Urology, Akita University School of Medicine, Akita, Japan., Advanced Medicine, Innovation and Clinical Research Center, Tottori University Hospital, Tottori, Japan., Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan., Department of Urology, Tokushima University Graduate School, Tokushima, Japan.