Perioperative Outcomes of Robotic Assisted Radical Prostatectomy in Elder Patients

Chyau-Wen Lin¹, Tzu-Hao Huang^1,2, Yu- Kuang Chen¹, Yen-Hwa Chang^1,2,
Shing-Hwa Lu^1,2, Hsiao-Jen Chung^1,2, Yi-Hsiu Huang^1,2, Tzu-Ping Lin^1,2,
 Chih-Chieh Lin ^1,2, I-Shen Huang^1,2, Wei-Jen Chen^1,2, Kuan-Jung Lin^1,2,
William J. Huang^1,2

1Department of Urology, Taipei Veterans General Hospital, Taiwan

2Department of Urology, School of Medicine and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan

年長攝護腺癌病人接受機械手臂之周術期結果比較

林巧文¹、黃子豪^1,2、陳昱光¹、張延驊^1,2、盧星華^1,2、鍾孝仁^1,2、黃逸修^1,2、林子平^1,2、林志杰^1,2、黃奕燊^1,2、陳威任^1,2、林冠榮^1,2、黃志賢^1,2

1 台北榮民總醫院泌尿部

2 國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心

Introduction:

While proposing suitable treatment plan for localized prostate cancer, age is always a crucial factor for clinicians to determine the treatment option. Traditionally, surgeons tend to offer less invasive treatment for elder patients, as they are more vulnerable to the stress of major surgery. With the advent of robotic-assisted surgery and its wide adoption, patients undergoing prostatectomy now experience less perioperative stress and faster postoperative recovery. Our aim is to evaluate the perioperative outcomes in the patients who were older than 75 and underwent robotic-assisted radical prostatectomy (RaRP) for localized prostate cancer.

Method:

All patients received RaRP in Taipei Veterans General Hospital during 2014-2019 were recruited retrospectively. The demographic information, basic lab data, and perioperative outcomes were collected through electronic medical records. We compared patients who were older than 75 years old with those who were younger. The outcomes of interest were postoperative length of stay, length of Foley indwelling, and 30-day major complications (Clavien-Dindo grade ≥ 3). A sensitivity analysis was applied by looking at the outcomes in high-volume surgeons, which was defined as surgeons who performed 15 or more RaRPs annually.

Results:

Of 630 patients who underwent RaRP during 2014-2019, 58(9.2%) patients were older than 75 years old. The elder patients had higher ASA score, higher Charlson Comorbidity Index (CCI), increased rate of hypoalbuminemia, and higher pathological T stage.

On multivariant analysis, patients with older age were associated with a longer period of postoperative length of Foley indwelling by 1 day (95% CI: 0.39 – 1.61, p<0.01). There was no significant difference between older and younger age patients in terms of postoperative length of stay and 30-day major complications.

For high-volume surgeons, all three outcomes of interest were not significantly different between older and younger patients.

Conclusion:

Our data showed that patients older than 75 years old could have a comparable postoperative recovery with younger patients after RaRP. The longer Foley indwelling period, which may attribute to vesico-urethral anastomosis leakage as a result of lack of experience in robotic surgery, was not observed in high-volume surgeons. This result suggests that with appropriate selection, elder patients can undergo RaRP smoothly without experiencing more postoperative morbidities. Thus, age should not be a contraindication for patient who is a candidate for RaRP after comprehensive evaluation.