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Published on: January 3, 2020
Robot-assisted vs. open radical cystectomy: octogenarians vs. non octogenarians
Michele Nicolazzini1, Mattia Longoni2, Fabian Falkenbach3
1Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy; Division of Urology, Department of Oncology, University of Turin, Turin, Italy.
Robot-assisted radical cystectomy (RARC) shows better in-hospital outcomes than open radical cystectomy (ORC) for both elderly and younger patients. However, the benefits of RARC are less significant in octogenarians compared to non-octogenarians.
Area of Science:
- Urology
- Surgical Oncology
- Geriatric Surgery
Background:
- Radical cystectomy (RC) is a standard treatment for bladder cancer.
- Comparing robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) is crucial, especially for elderly patients (octogenarians, ≥80 years).
- Adverse in-hospital outcomes following RC require careful evaluation across different age groups.
Purpose of the Study:
- To quantify the comparative effect of RARC versus ORC on in-hospital outcomes.
- To assess these outcomes specifically in octogenarians relative to non-octogenarians.
- To identify specific adverse events influenced by surgical approach in different age demographics.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2008-2019.
- Included 13,922 patients who underwent radical cystectomy (RC).
- Employed propensity score matching (PSM) and multivariable regression models to compare RARC and ORC outcomes in octogenarian and non-octogenarian cohorts.
Main Results:
- Octogenarians undergoing RARC had significantly lower rates of blood transfusions (18.6% vs. 28.1%) and prolonged length of stay (LOS) (17.7% vs. 25.5%) compared to ORC.
- Non-octogenarians on RARC showed reduced rates in blood transfusion (12.6% vs. 23.2%), prolonged LOS (18.8% vs. 26.1%), overall complications (57.8% vs. 62.9%), respiratory (9.1% vs. 11.5%), wound (2.2% vs. 4.3%), and infectious complications (4.2% vs. 5.6%) versus ORC.
- While RARC demonstrated benefits in both groups, the magnitude of improvement was less pronounced in octogenarians.
Conclusions:
- Robot-assisted radical cystectomy (RARC) offers a more favorable in-hospital outcome profile compared to open radical cystectomy (ORC).
- These benefits extend to both octogenarian and non-octogenarian patient populations.
- The relative advantage of RARC over ORC is diminished in the octogenarian group.
