Data di Pubblicazione:
2014
Citazione:
PERIOPERATIVE AND ONCOLOGICAL OUTCOMES IN HIGH RISK ELDERLY PATIENTS / E. De Lorenzis, B. Rocco, S. Pigilam, K. Palmer, S. Samavedi, H..A. Muhsin, V. Patel. ((Intervento presentato al convegno 87° Congresso Nazionale SIU Società Italiana di Urologia tenutosi a Firenze nel 2014.
Abstract:
Aim of the study
ontroversy continues to exist concerning the treatment of choice for D’Amico high risk elderly patients.
The purpose of this study is to compare the perioperative and oncologic outcomes of robotic assisted radical
prostatectomy (RARP) in D’Amico high risk, propensity score-matched elderly and younger cohorts.
Materials and methods
From January 2008 through August 2012, 3818 patients underwent RARP at our institution by a single
surgeon (VP). Retrospective analysis of prospectively collected data from our Institutional Review Board
approved registry identified 80 D’Amico high risk patients, 70 years of age and over. A propensity scorematch analysis was conducted using multivariable analysis to compare elderly patients (age 70 and over) to
those under 70. The final two study cohorts – D’Amico high risk elderly patients (n=80) and D’Amico high
risk younger patients (n=80) constituted the clinical material for this comparative study of perioperative and
oncologic outcomes.
Results
Preoperative clinical characteristics were similar for the two matched groups. The operative time,
transfusion rate and intra-operative complications were similar for the two groups.The mean estimated blood
loss was significantly greater in younger patients (156.1 ± 84.2 mLvs 113.6 ± 67.7; p=0.002). No significant
differences were observed in laterality, ease of nerve sparing or surgeon subjectively assessed anastomosis
and pathological outcomes between the groups. No significant differences were found in postoperative
complication rates, overall pain scores, length of stay or duration of indwelling catheterization. At follow-up,
freedom from biochemical recurrence (BCR) in elderly patients was 85.0% vs. 83.8% in younger patients.
The mean time to BCR in elderly patients was 15.0 months (range, 2.3 to 38.8) and 14.5 months (range, 5.2
to 35.1) in younger patients.
Discussion
Conclusions
This study clearly demonstrates that RARP can be performed in D’Amico high risk elderly patients without
increasing perioperative morbidity and with oncologic outcomes comparable to high risk younger patients.
RARP in elderly patients presenting with localized prostate cancer should be considered a viable treatment
alternative based on the individual’s life expectancy.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
E. De Lorenzis, B. Rocco, S. Pigilam, K. Palmer, S. Samavedi, H..A. Muhsin, V. Patel
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