# Evaluation of the Safety of Robot‐Assisted Radical Cystectomy for Bladder Cancer in Octogenarians

## TL;DR

Robot-assisted surgery for bladder cancer is safe for elderly patients, with similar complication rates to younger patients, though they face longer hospital stays and more ileus.

## Contribution

This study evaluates the safety and outcomes of robot-assisted radical cystectomy in octogenarians with bladder cancer.

## Key findings

- Elderly patients had shorter operative times but longer hospital stays compared to younger patients.
- The complication rates were comparable between elderly and younger patients, though ileus was more common in the elderly group.
- Higher age, ileus, and delayed drain removal were factors prolonging hospitalization in elderly patients.

## Abstract

Open radical cystectomy is the current standard treatment for bladder cancer. However, it is associated with high morbidity and mortality, particularly in the elderly. Recently, robotic surgery has become a minimally invasive approach. To this end, we aimed to evaluate the safety and complications of robot‐assisted radical cystectomy (RARC) in elderly patients with urothelial carcinoma.

We performed a retrospective single‐center analysis of 103 patients who underwent RARC between May 2018 and May 2024. The patients were divided into an elderly group (age, ≥ 80 years; n = 24) and a younger group (n = 79).

The American Society of Anesthesiologists Physical Status Classification System scores were significantly lower in the elderly group than in the younger group. No significant differences were observed between the two groups in terms of demography. Operative time was shorter in the elderly group than in the younger group. Conversely, the postoperative hospital stay was shorter in the younger group than in the elderly group. There were no significant differences in the frequency or severity of complications between the two groups; however, the incidence of ileus was significantly higher in the elderly group. In addition, higher age, ileus, and days to drain removal were identified as independent factors that prolonged hospitalization.

RARC is a safe treatment option for elderly patients with bladder cancer, with complication profiles comparable to those in younger patients. However, the increased risk of ileus and prolonged hospitalization in elderly patients highlights the need for cautious perioperative management to optimize outcomes in this growing population.