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Perioperative outcomes of open versus robot-assisted radical cystectomy in octogenarians: a population based analysis

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Abstract

Octogenarians undergoing cystectomy experience higher morbidity and mortality compared to younger patients. Though the non-inferiority of robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) has been established in a generalized population, the benefits of the robotic approach have not been well studied in an aged population. The National Cancer Database (NCDB) was queried for all patients who underwent cystectomy for bladder cancer from 2010 to 2016. Of these, 2527 were performed in patients age 80 or older; 1988 and 539 underwent ORC and RARC, respectively. On Cox regression analysis, RARC was associated with significantly reduced odds for both 30- and 90-day mortality (HR 0.404, p = 0.004; HR 0.694, p = 0.031, respectively), though the association with overall mortality was not significant (HR 0.877, p = 0.061). The robotic group had a significantly shorter length of stay (LOS) compared to open surgery (10.3 days ORC vs. 9.3 days RARC, p = 0.028). The proportion of cases performed robotically increased over the study period from 12.2% in 2010 to 28.4% in 2016 (p = 0.009, R2 = 0.774). The study is limited by a retrospective design and a section bias, which was not completely control for in the analysis. In conclusion, RARC provides improved perioperative outcomes in aged patients compared to ORC and a trend toward greater utilization of this technique was observed.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA

    Connor H. Ray & Johar Raza

  2. H. Lee Moffitt Cancer Institute and Research Center, Tampa, FL, USA

    Facundo Davaro

  3. Division of Urology, Saint Louis University, St. Louis, MO, USA

    Zachary A. Hamilton

Authors
  1. Connor H. Ray
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  2. Facundo Davaro
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  3. Zachary A. Hamilton
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  4. Johar Raza
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Contributions

All authors contributed to the study conception and design. All authors read and approved the final manuscript. FD, ZH, and JR were involved in the conceptualization of this projection. ZH was responsible for the data acquisition and analysis. CR wrote the original manuscript and created the figures for publication. All authors were involved in the editing, review, and finalization of the manuscript

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Correspondence to Johar Raza.

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Ray, C.H., Davaro, F., Hamilton, Z.A. et al. Perioperative outcomes of open versus robot-assisted radical cystectomy in octogenarians: a population based analysis. J Robotic Surg 17, 1629–1635 (2023). https://doi.org/10.1007/s11701-023-01568-0

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  • DOI: https://doi.org/10.1007/s11701-023-01568-0

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