A meta-analytic appraisal of robotic-assisted cystectomy outcomes in the elderly octogenarian population.

Abstract

Objective: This analysis aims to compare the outcomes of robotic cystectomy in patients with bladder cancer who are under 80 years of age versus those who are 80 years or older.

Materials and methods: A thorough search was conducted across key databases, including Google Scholar, Cochrane Library, PubMed, EMBASE, and Web of Science, with the most recent search conducted in July 2024. Data analysis was performed using Stata 18, applying a random-effects meta-analysis model. Weighted mean differences were calculated for continuous data, and odds ratios for categorical variables, accompanied by 95% confidence intervals.

Results: Four studies were included in the meta-analysis. The baseline data revealed significant differences in age, sex distribution, BMI, ASA scores (≥ 3), and cT2 staging between the two age groups. Patients aged 80 and above had significantly longer surgical durations and a greater number of lymph nodes removed compared to those under 80. Marked heterogeneity was observed in the younger cohort, which showed higher rates of urinary diversion to the neobladder and pelvic lymph node dissection. Blood loss, hospitalization duration, total complications, minor complications, and major complications did not differ notably between the age groups.

Conclusion: This study suggests that robot-assisted radical cystectomy (RARC) is a viable and safe procedure for carefully selected elderly patients when performed in high-volume specialized centers. However, the small sample size, intermediate follow-up period, and potential for selection bias warrant caution in interpreting long-term outcomes. Future multi-center studies with longer follow-ups are needed to confirm these findings and establish standardized criteria for patient selection.