Cytoreductive nephrectomy in the elderly: A population-based cohort from the USA

Maxine Sun, Firas Abdollah, Jan Schmitges, Marco Bianchi, Zhe Tian, Shahrokh F. Shariat, Kevin Zorn, Daniel Pharand, Hugues Widmer, Markus Graefen, Francesco Montorsi, Paul Perrotte, Pierre I. Karakiewicz

Research output: Contribution to journalArticle

Abstract

Study Type - Therapy (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? While cytoreductive nephrectomy is associated with a survival benefit in the context of metastatic renal cell carcinoma, the rates of morbidity and perioperative mortality remain non-negligible. For example, perioperative mortality may be as high as 21% in elderly patients. The study shows that perioperative death amongst the elderly was substantially lower than what was previously reported from a single institutional report. Nonetheless, postoperative adverse outcomes were non-negligible in elderly patients relative to their younger counterparts. In consequence, these rates should be discussed at informed consent and a rigorous patient selection remains essential. OBJECTIVE To examine the rate of perioperative mortality (PM), and other adverse outcomes in 'elderly' patients treated with cytoreductive nephrectomy (CNT). MATERIAL AND METHODS Patients who underwent CNT for metastatic renal cell carcinoma were abstracted from the Nationwide Inpatient Sample (1998-2007). 'Elderly' was defined as ≥75 years, according to previous definition. Endpoints consisted of PM, intraoperative and postoperative complications, blood transfusions and length of stay. We adjusted for the effect of elderly status within five separate logistic regression models. Covariates consisted of comorbidity, race, gender, year of surgery and hospital region. RESULTS Overall, CNT was performed in 504 (15.3%) elderly patients and in 2796 (84.7%) 'younger' patients (

Original languageEnglish
Pages (from-to)1807-1812
Number of pages6
JournalBJU International
Volume109
Issue number12
DOIs
Publication statusPublished - Jun 2012

Keywords

  • complications
  • cytoreductive nephrectomy
  • elderly
  • metastatic renal cell carcinoma
  • morbidity
  • perioperative mortality

ASJC Scopus subject areas

  • Urology

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    Sun, M., Abdollah, F., Schmitges, J., Bianchi, M., Tian, Z., Shariat, S. F., Zorn, K., Pharand, D., Widmer, H., Graefen, M., Montorsi, F., Perrotte, P., & Karakiewicz, P. I. (2012). Cytoreductive nephrectomy in the elderly: A population-based cohort from the USA. BJU International, 109(12), 1807-1812. https://doi.org/10.1111/j.1464-410X.2011.10569.x