Opportunities of robotic surgery in treatment of prostate cancer and renal masses in patients with severe comorbidities
https://doi.org/10.18705/3034-7270-2025-1-2-94-102
Abstract
Earlier diagnosis of cancer, increased effectiveness of therapeutic measures in combination with improved surgical treatment methods have led to improved prognosis and functional outcomes for patients, increased life expectancy and constant expansion of survival boundaries, as well as an increase in the proportion of patients with comorbidities. With the increase in life expectancy and population aging in general, the problem of comorbidity and "frailty" and the treatment of oncourological diseases in this group of patients are currently receiving increasing attention. Over the past decades, approaches to the management of such patients have changed significantly in favor of expanding the indications for radical treatment. At the same time, robot-assisted surgery, as one of the most modern, effective and safe methods, seems to be an extremely promising way to treat prostate cancer and kidney tumors in patients with severe comorbidities. This article presents world data on the treatment of prostate cancer and kidney cancer in comorbid patients using robotic surgery, as well as our own results of these methods.
About the Authors
D. A. ShelipanovRussian Federation
Shelipanov Denis A. – Candidate of Medical Sciences, Assistant Lecturer of the Department of Urology with a Course of Robotic Surgery with Clinic
St. Petersburg
D. A. Fedorov
Russian Federation
Fedorov Dmitry A. – Assistant Lecturer of the Department of Urology with a Course of Robotic Surgery with Clinic
St. Petersburg
N. A. Antipova
Russian Federation
Antipova Nadezhda A. – Assistant Lecturer of the Department of Urology with a Course of Robotic Surgery with Clinic
St. Petersburg
A. A. Vasilev
Russian Federation
Vasilev Artyom A. – Assistant Lecturer of the Department of Urology with a Course of Robotic Surgery with Clinic
St. Petersburg
E. S. Gilev
Russian Federation
Gilev Evgeny S. – Assistant Lecturer of the Department of Urology with a Course of Robotic Surgery with Clinic
St. Petersburg
A. M. Simonyan
Russian Federation
Simonyan Artur M. – Postgraduate Student of the Department of Urology with a Course of Robotic Surgery with Clinic
St. Petersburg
M. S. Mosoyan
Russian Federation
Mosoyan Mkrtich S. – Doctor of Medical Sciences, Professor, Head of the Department of Urology with a Course of Robotic Surgery with Clinic
St. Petersburg
References
1. Aburto J.M., Villavicencio F., Basellini U., et al. Dynamics of life expectancy and life span equality. Proceedings of the National Academy of Sciences. 2020;117(10):5250–5259. DOI: 10.1073/pnas.1915884117
2. Liou L., Joe W., Kumar A., et al. Inequalities in life expectancy: An analysis of 201 countries, 1950–2015. Social Science & Medicine. 2020;253:112964. DOI: 10.1016/j.socscimed.2020.112964
3. Drapkina O.M., Samorodskaya I.V., Larina V.N. Challenges and perspectives of preventive medicine in primary care. The Russian Journal of Preventive Medicine. 2018;21(5):15–21. DOI: 10.17116/profmed20182105115 (In Russ.).
4. Rohrmann S. Epidemiology of frailty in older people. Frailty and cardiovascular diseases: Research into an elderly population. 2020;21–27. DOI: 10.1007/978-3-030-33330-0_3
5. Verschoor C.P., Theou O., Ma J., et al. Age-and sex-specific associations of frailty with mortality and healthcare utilization in community-dwelling adults from Ontario, Canada. BMC Geriatrics. 2024;24(1):1–10. DOI: 10.1186/s12877-024-04842-4
6. Ofori-Asenso R., Chin K.L., Sahle B.W., et al. Frailty confers high mortality risk across different populations: evidence from an overview of systematic reviews and meta-analyses. Geriatrics. 2020;5(1):17. DOI: 10.3390/geriatrics5010017
7. Aceto P., Bassi P., Sollazzi L., et al. Implementation of frailty preoperative assessment to predict outcome in patients undergoing urological surgery: a systematic review and meta-analysis. BJU international. 2021;127(5):507–517. DOI: 10.1111/bju.15314
8. Rosiello G., Re C., Larcher A., et al. The effect of frailty on post-operative outcomes and health care expenditures in patients treated with partial nephrectomy. European Journal of Surgical Oncology. 2022;48(8):1840–1847. DOI: 10.1111/bju.15314
9. Ramirez D., Maurice M.J., Caputo P.A., et al. Frailty is an independent predictor of major post-operative complication after robotic partial nephrectomy: MP64-03. Journal of Urology. 2016;195(4):e830–e831. DOI: 10.1016/J.JURO.2016.02.953
10. Rosiello G., Palumbo C., Knipper S., et al. Preoperative frailty predicts adverse short-term postoperative outcomes in patients treated with radical prostatectomy. Prostate cancer and prostatic diseases. 2020;23(4):573–580. DOI: 10.1038/s41391-020-0225-3
11. Choi E., George A., Jakubski S., et al. Frailty is an independent predictor of 90-day complications following robot-assisted radical prostatectomy. The Southwest Respiratory and Critical Care Chronicles. 2022;10(44):15–21. DOI: 10.12746/swrccc.v10i44.1063
12. Kodama H., Hatakeyama S., Momota M., et al. Effect of frailty and comorbidity on surgical contraindication in patients with localized prostate cancer (FRART-PC Study). Urologic Oncology. 2020;39(3):191.e1–191.e8. DOI: 10.1016/j.urolonc.2020.06.019
13. Rosiello G., Palumbo C., Deuker M., et al. Partial nephrectomy in frail patients: Benefits of robot-assisted surgery. Surgical oncology. 2021;38:101588. DOI: 10.1016/j.suronc.2021.101588
14. Simonyan A.M., Mosoyan M.S., Shanava G.Sh., et al. Robot-assisted surgery of renal cell carcinoma in comorbid and frail patients. Urology reports. 2024;14(1):5–13. DOI: 10.17816/uroved.141 (In Russ).
15. Zingerenko M. B., Mirzoev K. M. Robot-assisted radical prostatectomy in elderly patients with prostate cancer: our experience. Clinical gerontology. 2017;23(9–10):26–28. (In Russ.)
16. Yamada Y., Taguchi S., Kume H. Surgical tolerability and frailty in elderly patients undergoing robot-assisted radical prostatectomy: a narrative review. Cancers. 2022;14(20):5061.16. DOI: 10.3390/cancers14205061
17. Charlson M.E., Carrozzino D., Guidi J., et al. Charlson comorbidity index: a critical review of clinimetric properties. Psychotherapy and psychosomatics. 2022;91(1):8–35. DOI: 10.1159/000521288
18. Nguyen S., Kim R.B., Cox P., et al. Impact of modified Frailty Index-11 (mFI-11) on postoperative complications in patients undergoing transsphenoidal resection of pituitary tumors: analysis of 2006–2014 ACS-NSQIP database. Journal of Clinical Neuroscience. 2021;92:22–26. DOI: 10.1016/j.jocn.2021.07.046
19. Goldwag J., Harris A., Bettis A.D. 5-Item modified frailty index as a preoperative predictor of morbidity following minimally invasive partial nephrectomy. Urology. 2021;157:138–142. DOI: 10.1016/j.urology.2021.05.050
20. Leyh-Bannurah S.R., Wagner C., Schuette A., et al. Feasibility of robot-assisted radical prostatectomy in men at senior age≥ 75 years: perioperative, functional, and oncological outcomes of a high-volume center. The Aging Male. 2022;25(1):8–16. DOI: 10.1080/13685538.2021.2018417
21. Petersson R.D., Fode M., Niebuhr M.H., et al. Robot-assisted partial nephrectomy in patients aged 75 years or older–comparing the risk of complications with their younger counterparts. Aging clinical and experimental research. 2024;36(1):107. DOI: 10.1007/s40520-024-02751-5
22. Mottet N., van den Bergh R.C., Briers E., et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer – 2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. European urology. 2021;79(2):243–262. DOI: 10.1016/j.eururo.2020.09.042
23. Ljungberg B., Albiges L., Abu-Ghanem Y., et al. European Association of Urology guidelines on renal cell carcinoma: the 2022 update. European urology. 2022;82(4):399–410. DOI: 10.1016/j.eururo.2022.03.006
24. Abou Heidar N.F., Ayoub C.H., Abou Mrad A., et al. Robotic-assisted radical prostatectomy is pushing the boundaries: A national survey of frailty using the national surgical quality improvement program. Therapeutic Advances in Urology. 2023;15:17562872231177780. DOI: 10.1177/17562872231177780
25. Kostakopoulos N., Bellos T., Malovrouvas E., et al. Robot-Assisted Urological Oncology Procedures, Outcomes, and Safety in Frail Patients: A Narrative Review of Available Studies. Urology Research & Practice. 2024;50(1):36–41. DOI: 10.5152/tud.2024.23198
Review
For citations:
Shelipanov D.A., Fedorov D.A., Antipova N.A., Vasilev A.A., Gilev E.S., Simonyan A.M., Mosoyan M.S. Opportunities of robotic surgery in treatment of prostate cancer and renal masses in patients with severe comorbidities. Russian surgical journal. 2025;1(2):94-102. (In Russ.) https://doi.org/10.18705/3034-7270-2025-1-2-94-102