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Peri-operative efficacy and long-term survival benefit of robotic-assisted radical cystectomy in septuagenarian patients compared with younger patients: a nationwide multi-institutional study in Japan

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International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

Using RARC potentially allows the application of less invasive procedures and cancer control for septuagenarian patients that are equivalent to those for younger patients.

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Acknowledgements

These clinicopathological statistics are based on the results from a number of institutions in Japan. We are grateful for the cooperation of many Japanese urologists. This document was created by the Japanese Society of Endourology. Cooperative institutions for the present study are: Department of Urology, the University of Tokyo Graduate School of Medicine; Department of Urology, Kobe University Graduate School of Medicine; Department of Urology, Hamamatsu University School of Medicine; Department of Urology, Iwate Medical University School of Medicine; Department of Urology, Kagawa University, Faculty of Medicine,; Department of Urology, Shiga University of Medical Science; Department of Urology, Takamatsu Red Cross Hospital; Department of Urology, Teine Keijinkai Medical Center; Department of Urology, Kobe City Medical Center General Hospital; Ibaraki Clinical Education and Training Center, Faculty of Medicine; Department of Urology, St. Luke’s International Hospital; Department of Urology, Wakayama Medical University: Department of Urology, Kyoto City Hospital; Department of Urology, Nagoya University Graduate School of Medicine; Department of Urology, Kyoto University Hospital; Department of Urology, Ehime Prefectural Central Hospital; Department of Urology, Gifu Prefectural General Medical Center; Department of Urology, Hiroshima City Hiroshima Citizens Hospital; Department of Urology Aichi Medical University School of Medicine; Department of Urology, Kitasato University School of Medicine; Department of Urology, Ehime University Graduate School of Medicine; Department of Urology, Shizuoka General Hospital; Department of Urology, Tohoku University Graduate School of Medicine; Department of Urology, Tokyo Medical University; Department of Urology, Tokushima University Graduate School; Department of Urology, Akita University School of Medicine; Department of Urology, Institute of Biomedical and Health Science, Hiroshima University; Department of Urology, Kochi Medical School, Kochi University; Department of Urology, Hirosaki University Graduate School of Medicine; Department of Urology, Fujita Health University; Department of Urology, Juntendo University; Department of Urology, Shimane University School of Medicine; Department of Urology, Jyoban Hospital of Tokiwa Foundation; Division of Urology, Department of Surgery, Tottori University Faculty of Medicine.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 86 Nishi-cho, Yonago, Tottori, 683-8504, Japan

    Hideto Iwamoto, Shuichi Morizane & Atsushi Takenaka

  2. Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

    Takuya Koie

  3. Department of Urology, Fujita Health University, Toyoake, Japan

    Ryoichi Shiroki

  4. Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan

    Mutsushi Kawakita

  5. Department of Urology, Tokyo Medical University, Tokyo, Japan

    Tatsuo Gondo

  6. Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan

    Kazumasa Matsumoto

  7. Department of Urology, Akita University School of Medicine, Akita, Japan

    Tomonori Habuchi

  8. Advanced Medicine, Innovation and Clinical Research Center, Tottori University Hospital, Tottori, Japan

    Hiroshi Sunada & Yusuke Endo

  9. Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan

    Hisashi Noma

  10. Department of Urology, Tokushima University Graduate School, Tokushima, Japan

    Hiroomi Kanayama

Authors
  1. Hideto Iwamoto
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  2. Shuichi Morizane
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Correspondence to Hideto Iwamoto.

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Iwamoto, H., Morizane, S., Koie, T. et al. Peri-operative efficacy and long-term survival benefit of robotic-assisted radical cystectomy in septuagenarian patients compared with younger patients: a nationwide multi-institutional study in Japan. Int J Clin Oncol 24, 1588–1595 (2019). https://doi.org/10.1007/s10147-019-01470-6

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  • DOI: https://doi.org/10.1007/s10147-019-01470-6

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