Comparison of perioperative outcomes in elderly (age ≧ 75 years) vs. younger men undergoing robot-assisted radical prostatectomy

Abstract

Objectives To investigate perioperative, oncologic, and functional outcomes of robot-assisted radical prostatectomy (RARP) in men of age � 75 years in comparison with younger men. Methods From November 2011 to December 2018, six hundred and thirty patients with prostate cancer underwent robot-assisted radical prostatectomy (RARP). A total of 614 patients were analyzed after excluding 16 patients who were treated with hormone therapy prior to RARP. Patients were divided into 2 groups based on their age (age � 75 years: N = 46 patients and age < 75 years: N = 568 patients). Perioperative parameters regarding oncologic/functional outcomes and complication status were compared between the 2 groups. Clavien-Dindo classification was used to classify perioperative complications. Clinical and pathological status including stage, positive margin, continence, and potency status after RARP were analyzed. Results Five-hundred sixty-eight and forty-six men were of age <75 and � 75 years, respectively. There were no significant differences between the 2 groups in terms of oncologic outcomes (positive resection margin rate and PSA failure). The duration of hospitalization was longer in older patients but was not statistically significant (P = 0.051). A total number of Clavien �3 complications that occurred within a month after RARP were 15 (2.6%) and 2 (4.3%) in younger men (age < 75 years) and older men (age � 75 years), respectively (P = 0.359).

Clinical significance and risk factors of urethrovesical anastomotic urinary leakage following robot-assisted radical prostatectomy: a multi-institutional study

“…We hypothesized that surgeon experience may be related to AUL and included surgeon experience as a factor, but we did not identify any association with the surgeon volume and AUL in our cohort. This may partly be due to the unique mentoring system we implemented, in which RARP was divided into sections, each with a designated time limit and blood loss criteria, and an experienced surgeon replaced an inexperienced surgeon for the remainder of the section upon exceeding the designated time or blood loss [ 10 , 25 ].…”

Clinical significance and risk factors of International Society of Urological Pathology (ISUP) grade upgrading in prostate cancer patients undergoing robot-assisted radical prostatectomy

“…The da Vinci surgical robot system (da Vinci-S or Xi®: Intuitive Surgical Incorporation, Sunnyvale, CA) was used in performing RARP. As described in our previous studies, RARP was performed using the transperitoneal, 6 port technique [ 10 , 11 ]. Sixteen patients were treated with androgen deprivation therapy prior to RARP and were excluded from this study.…”

Perioperative adverse events and functional outcomes following open and robot‐assisted prostatectomy in patients over age 70

“…However, there is yet no consensus on how these physiological changes are clinically reflected on perioperative adverse events. These effects are evaluated according to the Clavien–Dindo classification system in studies and are classified as class 4 and 5 complications 2,5,11,17 . In their recent review article, Mandel et al concluded that elderly patients (75 years or older) with higher ASA scores had an increased risk of experiencing perioperative adverse events compared with younger men 18 .…”