Introduction:

Robotic-assisted radical cystectomy (RARC) is becoming increasingly popular. However, its role in improving perioperative outcome is controversial. Octogenarians face higher operative risk and may derive more benefit from the reduced surgical trauma of minimally invasive surgery. 

Methods:

Using the Premier Healthcare Database, we found 13,127 patients who underwent robotic-assisted radical cystectomy between 2008 and 2017, of which 15.1% were ≥80 years old. RARC was compared to open radical cystectomy (ORC) and perioperative mortality was the primary outcome of interest. We also assessed postoperative length of stay, readmission and complication rates. Univariate analysis was performed using the Wilcoxon rank-sum or Chi-square test.Multivariable regression analysis was used to adjust for baseline characteristics including patient gender, Charlson comorbidity index, hospital location, academic status, hospital size, annual hospital volume, and annual surgical volume.

Results:

In octogenarians, mortality at the index admission was 2.2% in those who underwent RARC, compared to 4.6% in those who underwent open surgery (P=0.027). On multivariable analysis, robotic surgery was associated with lower in-hospital mortality in octogenarians (OR 0.47, 95% CI 0.22-0.99, P=0.048) even after controlling for baseline characteristics. This survival advantage was not seen in patients 79 years old and younger. In addition, RARC was associated with a 1-day reduction in hospital LOS (95% CI -1.4 to -0.5, P<0.001), but higher readmission rates (OR 1.36, 95% CI 1.08-1.72, P=0.01). There was no significant difference in 90-day postoperative complication rates.

Conclusion:

Older patients tend to be frailer and more sensitive to perioperative stress. RARC may benefit this population more than in younger patients, especially in the early postoperative period. 

Funding: N/A