Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge)

A. Antonelli, A. Veccia, N. Pavan, C. Mir, A. Breda, T. Takagi, K.H. Rha, T. Maurer, C. Zhang, J.-A. Long, C. De Nunzio, E. Lima, M. Ferro, S. Micali, G. Quarto, E. Linares, A. Celia, L. Schips, P. Bove, A. LarcherC. Fiori, A. Mottrie, A. Bindayi, C. Trombetta, T. Silvestri, J. Palou, O.R. Faba, K. Tanabe, B. Yang, G. Fiard, A. Tubaro, J.N. Torres, O. De Cobelli, L. Bevilacqua, R. Castellucci, A. Tracey, L.J. Hampton, F. Montorsi, S. Perdonà, C. Simeone, C. Palumbo, U. Capitanio, I. Derweesh, F. Porpiglia, R. Autorino

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To analyze the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in octogenarian patients. METHODS: The RESURGE (REnal SUrgery in the Eldely) multi-institutional database was queried to identify patients ≥80 years old who had undergone a PN or RN for a renal tumor. Multivariable binary logistic regression estimated the association between type of surgery and occurrence of complications. Multivariable Cox regression model assessed the association between type of surgery and All-Causes Mortality. RESULTS: The study analyzed 585 patients (median age 83 years, IQR 81-84), 364 of whom (62.2%) underwent RN and 221 (37.8%) PN. Patients undergoing RN were older (P = .0084), had larger tumor size (P <.0001) and higher clinical stage (P <.001). At multivariable analysis for complications, the only significant difference was found for lower risk of major postoperative complications for laparoscopic RN compared to open RN (OR: 0.42; P = .04). The rate of significant (>25%) decrease of eGFR in PN and RN was 18% versus 59% at 1 month, and 23% versus 65% at 6 months (P <.0001). After a median follow-up time of 39 months, 161 patients (31%) died, of whom 105 (20%) due to renal cancer. CONCLUSION: In this patient population both RN and PN carry a non-negligible risk of complications. When surgical removal is indicated, PN should be preferred, whenever technically feasible, as it can offer better preservation of renal function, without increasing the risk of complications. Moreover, a minimally invasive approach should be pursued, as it can translate into lower surgical morbidity. © 2019 Elsevier Inc.
Original languageEnglish
Pages (from-to)139-145
Number of pages7
JournalUrology
Volume129
DOIs
Publication statusPublished - 2019

Keywords

  • aged
  • all cause mortality
  • Article
  • cancer mortality
  • cancer staging
  • cohort analysis
  • disease association
  • estimated glomerular filtration rate
  • female
  • follow up
  • human
  • kidney tumor
  • laparoscopic surgery
  • major clinical study
  • male
  • open surgery
  • partial nephrectomy
  • patient identification
  • postoperative complication
  • priority journal
  • radical nephrectomy
  • retrospective study
  • surgical risk
  • treatment outcome
  • tumor volume
  • very elderly
  • Asia
  • clinical trial
  • Europe
  • incidence
  • mortality
  • multicenter study
  • nephrectomy
  • procedures
  • renal cell carcinoma
  • survival rate
  • United States
  • Aged, 80 and over
  • Carcinoma, Renal Cell
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Kidney Neoplasms
  • Male
  • Neoplasm Staging
  • Nephrectomy
  • Postoperative Complications
  • Retrospective Studies
  • Survival Rate

Fingerprint

Dive into the research topics of 'Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge)'. Together they form a unique fingerprint.

Cite this