Laparoscopy and Robotics Feasibility and Outcomes of Robotic-assisted Laparoscopic Radical Cystectomy for Bladder Cancer in Older Patients Robert M. Coward, Angela Smith, Mathew Raynor, Matthew Nielsen, Eric M. Wallen, and Raj S. Pruthi OBJECTIVES To report our maturing experience with robotic radical cystectomy as applied to an older patient population with regard to perioperative measures and pathologic outcomes. A robotic approach to radical cystectomy for bladder cancer have recently been described, but its application in an older patient population, which is often the case in bladder cancer and cystectomy, has not yet been assessed. METHODS A total of 119 patients underwent robotic cystectomy and extracorporeal urinary diversion at our institution from January 2006 through October 2009 for clinically localized bladder cancer. Owing to the patient selection early in the present series, the first 20 cases were excluded. The clinical characteristics, operative outcomes, and pathologic results of the consecutive cases were categorized by age (younger, 70 years vs older, age 70 years). RESULTS The outcomes of the 61 younger and 38 older patients, including 7 patients 80 years old, were assessed. The younger versus older patients had a lower American Society of Anesthesiologists score (2.6 vs 3.0; P  .001), greater body mass index (28.2 vs 26.1; P = .008), and longer operating room time (4.8 vs 4.4 hours; P = .015). No differences were observed between the 2 groups in blood loss, time to discharge, or complication rate. Also, no significant differences were found in the surgical pathologic findings, including the organ-confined rate (62% vs 71%) and lymph node yield (19.5 vs 18.1). CONCLUSIONS Older patients do not appear to have any significant differences or compromises with regard to the perioperative and pathologic outcomes after robotic radical cystectomy. Thus, robotic radical cystectomy appears to be an appropriate surgical option for older patients. UROLOGY 77: 1111–1115, 2011. © 2011 Elsevier Inc. B ladder cancer is most commonly diagnosed in older patients, with a dramatically increased inci- dence after 70 years of age. 1 In addition to the high incidence of bladder cancer in older patients, census data have also demonstrated that the older population has continued to grow rapidly. For example, according to U.S. Census statistics from 2008, the population aged 65 years is projected to double within the next 30 years. 2 Accordingly, during the past 20 years, the number of bladder cancers diagnosed annually in the United States has increased by 50%, and this appears to be primarily related to our aging population. 3 Thus, all available treatments of bladder cancer must be applied to an increasingly older cohort. Radical cystectomy remains 1 of the most effective treatment options for patients with clinically localized, muscle-invasive bladder cancer and for certain patients with recurrent noninvasive tumors. The safety and effi- cacy of the reference standard, the open technique of radical cystectomy, in the elderly population has been previously demonstrated. 4-9 Recently, some surgeons have begun to describe the outcomes after less-invasive surgical approaches, such as laparoscopic or robotic-as- sisted techniques for radical cystectomy. Acceptable sur- gical and perioperative results after robotic-assisted lapa- roscopic radical cystectomy have been demonstrated. 10-13 The potential benefits of the robotic approach to radical cystectomy include lower surgical blood loss, a quicker return of bowel function, and shorter hospital stay. 10,12,13 The clinical and oncologic endpoints after robotic-as- sisted radical cystectomy have been reported but only for short-term follow-up. In a study of 50 consecutive pa- tients who had undergone robotic-assisted radical cystec- tomy with 13 months of follow-up, the outcomes were favorable. However, the technique is still in an early From the Division of Urologic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Reprint requests: Raj S. Pruthi, M.D., Division of Urologic Surgery, University of North Carolina at Chapel Hill, 2113 Physicians Office Building CB 7235, 170 Manning Drive, Chapel Hill, NC 27599-7235. E-mail: rpruthi@med.unc.edu Submitted: February 7, 2010, accepted (with revisions): July 2, 2010 © 2011 Elsevier Inc. 0090-4295/11/$36.00 1111 All Rights Reserved doi:10.1016/j.urology.2010.07.510