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

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          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).

          Conclusion

          The present study showed that the oncologic and surgical outcomes in the elderly group were similar to those in the younger population. However, the duration of hospitalization seemed to be longer in older patients (age ≥ 75 years), despite similar complication rates.

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          Most cited references26

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          Proposed classification of complications of surgery with examples of utility in cholecystectomy.

          P A Clavien, J. Sanabria, S Strasberg (1992)
          Lack of uniform reporting of negative outcomes makes interpretation of surgical literature difficult. We attempt to define and classify negative outcomes by differentiating complications, sequelae, and failures. Complications and sequelae result from procedures, adding new problems to the underlying disease. However, complications are unexpected events not intrinsic to the procedure, whereas sequelae are inherent to the procedure. Failures are events in which the purpose of the procedure is not fulfilled. We propose a classification of complications based on four grades: Grade I complications are alterations from the ideal postoperative course, non-life-threatening, and with no lasting disability. Complications of this grade necessitate only bedside procedures and do not significantly extend hospital stay. Grade II complications are potentially life-threatening but without residual disability. Within grade II complications a subdivision is made according to the requirement for invasive procedures. Grade III complications are those with residual disability, including organ resection or persistence of life-threatening conditions. Finally, grade IV complications are deaths as a result of complications. To illustrate the relevance of the classification, we reviewed 650 cases of elective cholecystectomy. Risk factors for development of complications were determined, and the classification was also used to analyze the value of a modified APACHE II as a preoperative prognostic score. Both supported the relevance of the proposed classification. The advantages of such a classification are (1) increased uniformity in reporting results, (2) the ability to compare results of two distinct time periods in a single center, (3) the ability to compare results of surgery between different centers, (4) the ability to compare results of surgical versus nonsurgical measures, (5) the ability to perform adequate metaanalysis, (6) the ability to identify objective preoperative risk factors, and (7) the ability to establish preoperative prognostic scores.
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            Surgery Versus Radiotherapy for Clinically-localized Prostate Cancer: A Systematic Review and Meta-analysis.

            Christopher J D Wallis, Refik Saskin, Richard Choo … (2016)
            To date, there is no Level 1 evidence comparing the efficacy of radical prostatectomy and radiotherapy for patients with clinically-localized prostate cancer.
            Article 0 comments Cited 82 times – based on 0 reviews     Review now
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              A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer.

              Bo Johan Norlén, Hans-Olov Adami, Anders Spångberg … (2002)
              Radical prostatectomy is widely used in the treatment of early prostate cancer. The possible survival benefit of this treatment, however, is unclear. We conducted a randomized trial to address this question. From October 1989 through February 1999, 695 men with newly diagnosed prostate cancer in International Union against Cancer clinical stage T1b, T1c, or T2 were randomly assigned to watchful waiting or radical prostatectomy. We achieved complete follow-up through the year 2000 with blinded evaluation of causes of death. The primary end point was death due to prostate cancer, and the secondary end points were overall mortality, metastasis-free survival, and local progression. During a median of 6.2 years of follow-up, 62 men in the watchful-waiting group and 53 in the radical-prostatectomy group died (P=0.31). Death due to prostate cancer occurred in 31 of 348 of those assigned to watchful waiting (8.9 percent) and in 16 of 347 of those assigned to radical prostatectomy (4.6 percent) (relative hazard, 0.50; 95 percent confidence interval, 0.27 to 0.91; P=0.02). Death due to other causes occurred in 31 of 348 men in the watchful-waiting group (8.9 percent) and in 37 of 347 men in the radical-prostatectomy group (10.6 percent). The men assigned to surgery had a lower relative risk of distant metastases than the men assigned to watchful waiting (relative hazard, 0.63; 95 percent confidence interval, 0.41 to 0.96). In this randomized trial, radical prostatectomy significantly reduced disease-specific mortality, but there was no significant difference between surgery and watchful waiting in terms of overall survival. Copyright 2002 Massachusetts Medical Society
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                Author and article information

                Contributors
                Yuta Yamada:
                ORCID: http://orcid.org/0000-0002-9698-4301
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Taro Teshima: Role: Data curationRole: InvestigationRole: MethodologyRole: Validation
                Tetsuya Fujimura: Role: Data curationRole: InvestigationRole: SupervisionRole: Writing – review & editing
                Yusuke Sato: Role: Data curationRole: InvestigationRole: Methodology
                Masaki Nakamura: Role: Data curationRole: InvestigationRole: Methodology
                Aya Niimi: Role: Data curationRole: Investigation
                Naoki Kimura: Role: Data curationRole: InvestigationRole: MethodologyRole: Writing – original draft
                Shigenori Kakutani: Role: InvestigationRole: MethodologyRole: Writing – original draft
                Taketo Kawai: Role: InvestigationRole: Writing – review & editing
                Daisuke Yamada: Role: ConceptualizationRole: InvestigationRole: ValidationRole: Writing – review & editing
                Motofumi Suzuki: Role: SupervisionRole: Writing – review & editing
                Haruki Kume: Role: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Kathryn L. Penney: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 4 June 2020
                Publication date Collection: 2020
                Volume: 15
                Issue: 6
                Electronic Location Identifier: e0234113
                Affiliations
                [1 ] Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
                [2 ] Department of Urology, Jichi Medical University, Shimotsuke-shi, Tochigi-ken, Japan
                [3 ] Department of Urology, National Center for Global Health, Shinjuku-ku, Tokyo, Japan
                [4 ] Department of Urology, Mitsui Kinen Hospital, Tokyo, Japan
                Brigham and Women's and Harvard Medical School, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-9698-4301
                Article
                Publisher ID: PONE-D-19-28595
                DOI: 10.1371/journal.pone.0234113
                PMC ID: 7272059
                PubMed ID: 32497131
                SO-VID: 5f0241e8-e288-4f4c-986a-aa0433bd4cf4
                Copyright © © 2020 Yamada et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 13 October 2019
                Date accepted : 19 May 2020
                Page count
                Figures: 1, Tables: 4, Pages: 10
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Surgical and Invasive Medical Procedures
                Subject: Medicine and Health Sciences
                Subject: Oncology
                Subject: Cancer Treatment
                Subject: Surgical Oncology
                Subject: Medicine and Health Sciences
                Subject: Clinical Medicine
                Subject: Clinical Oncology
                Subject: Surgical Oncology
                Subject: Medicine and Health Sciences
                Subject: Oncology
                Subject: Clinical Oncology
                Subject: Surgical Oncology
                Subject: Medicine and Health Sciences
                Subject: Geriatrics
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Elderly
                Subject: Medicine and Health Sciences
                Subject: Oncology
                Subject: Cancer Treatment
                Subject: Medicine and Health Sciences
                Subject: Surgical and Invasive Medical Procedures
                Subject: Reproductive System Procedures
                Subject: Prostatectomy
                Subject: Radical Prostatectomy
                Subject: Medicine and Health Sciences
                Subject: Surgical and Invasive Medical Procedures
                Subject: Surgical Excision
                Subject: Prostatectomy
                Subject: Radical Prostatectomy
                Subject: Medicine and Health Sciences
                Subject: Oncology
                Subject: Cancers and Neoplasms
                Subject: Genitourinary Tract Tumors
                Subject: Prostate Cancer
                Subject: Medicine and Health Sciences
                Subject: Urology
                Subject: Prostate Diseases
                Subject: Prostate Cancer
                Subject: Biology and Life Sciences
                Subject: Population Biology
                Subject: Population Metrics
                Subject: Life Expectancy
                Subject: Medicine and Health Sciences
                Subject: Public and Occupational Health
                Subject: Life Expectancy
                Custom metadata
                Data Availability All relevant data are within the manuscript and its Supporting Information files.

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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