Robot-Assisted Radical Cystectomy in the Very Elderly: A Propensity Score-Matched Comparison of Outcomes Between Patients Aged ≥ 85 Versus 75-84 Years.

OBJECTIVES

This study evaluated the safety and efficacy of robot-assisted radical cystectomy (RARC) in patients aged ≥ 85 years versus 75-84 years, using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW).

METHODS

We retrospectively reviewed 479 RARC cases, including 26 patients aged ≥ 85 years and 193 aged 75-84 years, from four Japanese institutions (2014-2025). Patients were matched 1:2 by sex, ECOG-PS, ASA-PS, clinical stage, and neoadjuvant chemotherapy. Surgical outcomes, complications, and survival (OS, CSS, RFS) were analyzed. IPTW-adjusted Cox models assessed survival differences.

RESULTS

Postmatching, baseline characteristics were balanced except for age. Intracorporeal urinary diversion was performed for ileal conduit and orthotopic neobladder cases. Ureterostomy was more frequent in the ≥ 85-year group; LND was less frequent (67% vs. 92%, p = 0.024). Operative time was shorter (380 vs. 428 min, p = 0.041), while blood loss, transfusion, hospital stay, and complications were similar. Kaplan-Meier analysis showed lower 3-year OS in the ≥ 85-year group (59% vs. 83%, p = 0.042), whereas CSS (77% vs. 85%, p = 0.666) and RFS (55% vs. 71%, p = 0.662) were comparable. IPTW-adjusted Cox regression showed no significant differences in OS (HR 1.34, 95% CI 0.69-2.59, p = 0.386), CSS (HR 0.76, 95% CI 0.27-2.18, p = 0.613), or RFS (HR 0.81, 95% CI 0.35-1.87, p = 0.614).

CONCLUSIONS

RARC is feasible and safe in patients aged ≥ 85 years. Perioperative outcomes, CSS, and RFS were comparable to those aged 75-84 years, while lower OS likely reflects age-related factors, supporting RARC as a viable option for well-selected very elderly patients.