PD60-12: The Impact of Frailty Status on Surgical Outcomes after Robot-Assisted Radical Prostatectomy - A Prospective Assessment using a Standardized Collection System for Perioperative Outcomes

Giuseppe Rosiello*, Simone Scuderi, Giorgio Gandaglia, Elio Mazzone, Armando Stabile, Francesco Barletta, Antony Pellegrino, Lorenzo Toneatto, Donato Cannoletta, Leonardo Quarta, Gianmarco Colandrea, Riccardo Leni, Daniele Robesti, Milano, Italy, Umberto Capitanio, Alessandro Larcher, Milan, Italy, Andrea Salonia, Milano, Italy, Federico Dehò, Varese, Italy, Pierre I. Karakiewicz, Montreal, Canada, Francesco Montorsi, Alberto Briganti, Milano, Italy

Introduction: The risk of perioperative complications in prostate cancer (PCa) patients managed with robot-assisted radical prostatectomy (RARP) is not negligible. Although age and comorbidities are predictors of adverse outcomes after surgery, the evidence is scarce regarding the role of frailty. We aimed at investigating the impact of frailty status on postoperative outcomes in PCa men undergoing RARP.

Methods: We relied on a prospective database including 1,061 men treated with robot-assisted radical prostatectomy (RARP) ± extended pelvic lymph node dissection (ePLND) for localized PCa from November 2016 to July 2021 at a tertiary referral center. The Modified Frailty Index (MFI) was used to identify frail patients. Postoperative complications were prospectively collected using a standardized method based on the quality criteria for reporting of surgical outcomes recommended by the EAU Guidelines. Multivariable logistic regression tested the association between frailty status and risk of overall, Clavien-Dindo =2 complications, and anastomotic leakage after adjusting for age, BMI, clinical stage, biopsy ISUP group and ePLND.

Results: Overall, 1,061 patients were treated with RARP ± ePLND between 2016 and 2021. Of these, 115 (11%) were frail according to MFI. Frail patients were older (65 vs 69 yr; p<0.01) as compared to non-frail patients. Median PSA was 6.5 vs 7 ng/mL, median BMI 25 vs 26 kg/m2 (frail vs non-frail, all p>0.05). A total of 31 vs 45% of frail vs non-frail patients received ePLND. The overall rate of postoperative complications was 15%. Frailty status was associated with higher rates of overall complications (23 vs 14%; p=0.02) and Clavien-Dindo =2 complications (16 vs 10%; p=0.02). Rates of anastomotic leakage were higher in frail vs. non frail patients (5.2 vs 1.4%; p<0.01). Readmission rates were higher in frail vs. non-frail patients (15 vs 8%; p=0.03). Frailty status independently predicted increased risk of overall complications (OR 1.74, 95%CI 1.1-2.7; p=0.02) and anastomotic leakage (OR 2.83, 95%CI 1.2-8.4; p=0.03).

Conclusions: More than 1 out of 10 PCa patients receiving RARP at a tertiary referral center is frail. Frailty status is associated with increased risk of suboptimal surgical outcomes, frail patients are at higher risk of overall and severe complications. Preoperative assessment of frailty in patients undergoing RARP should be implemented to identify patients who are at increased risk of complications and may deserve a more careful counselling.

Source of Funding: None