Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses

Alessandro Veccia, Paolo Dell'oglio, Alessandro Antonelli, Andrea Minervini, Giuseppe Simone, Benjamin Challacombe, Sisto Perdoná, James Porter, Chao Zhang, Umberto Capitanio, Chandru P Sundaram, Giovanni Cacciamani, Monish Aron, Uzoma Anele, Lance J Hampton, Claudio Simeone, Geert de Naeyer, Aaron Bradshawh, Andrea Mari, Riccardo CampiMarco Carini, Cristian Fiori, Michele Gallucci, Ken Jacobsohn, Daniel Eun, Clayton Lau, Jad Kaouk, Ithaar H Derweesh, Francesco Porpiglia, Alexandre Mottrie, Riccardo Autorino

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Recent evidence suggests that the "oldest old" patients might benefit of partial nephrectomy (PN), but decisionmaking for this subset of patients is still controversial. Aim of this study is to compare outcomes of robotic partial (RPN) or radical nephrectomy (RRN) for large renal masses in patients older than 65 years.

METHODS: We identified 417 ≥65 years old patients who underwent robotic radical nephrectomy (RRN) or RPN for cT1b or ≥cT2 renal mass at 17 high volume centers. Propensity score match analysis was performed adjusting for age, ASA≥3, pre-operative eGFR, and clinical tumor size. Predictors of complications, functional and oncological outcomes were evaluated in multivariable logistic and Cox regression models.

RESULTS: After propensity score analysis, 73 patients in the RPN group were matched with 74 in the RRN group. R.E.N.A.L. Score (9.6±1.7 vs 8.6±1.7; p<0.001), and high complexity (56 vs 15%; p=0.001) were higher in the RRN. Estimated blood loss was higher in the RPN group (200 vs 100 mL; p<0.001). RPN showed higher rate of overall complications (38 vs 23%; p=0.05), but not major complications (p=0.678). At last follow-up, RPN group showed better functional outcomes both in eGFR (55.4±22.6 vs 45.7±15.7 mL/min; p=0.016) and lower eGFR variation (9.7 vs 23.0 mL/min; p<0.001). The procedure type was not associated with recurrence free survival (RFS) (HR: 0.47; p=0.152) and overall mortality (OM) (0.22; p=0.084).

CONCLUSIONS: RPN In elderly patientswith large renal masses provides RPN offers acceptable surgical, and oncological outcomes allowing better functional preservation relative to RRN. The decision to undergo RPN in this subset of patients should be tailored on a case by case basis.

Original languageEnglish
JournalMinerva urologica e nefrologica = The Italian journal of urology and nephrology
DOIs
Publication statusE-pub ahead of print - Sep 13 2019

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Robotics
Nephrectomy
Kidney
Propensity Score
Proportional Hazards Models
Research Design
Logistic Models
Recurrence
Survival
Mortality
Neoplasms

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Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses. / Veccia, Alessandro; Dell'oglio, Paolo; Antonelli, Alessandro; Minervini, Andrea; Simone, Giuseppe; Challacombe, Benjamin; Perdoná, Sisto; Porter, James; Zhang, Chao; Capitanio, Umberto; Sundaram, Chandru P; Cacciamani, Giovanni; Aron, Monish; Anele, Uzoma; Hampton, Lance J; Simeone, Claudio; de Naeyer, Geert; Bradshawh, Aaron; Mari, Andrea; Campi, Riccardo; Carini, Marco; Fiori, Cristian; Gallucci, Michele; Jacobsohn, Ken; Eun, Daniel; Lau, Clayton; Kaouk, Jad; Derweesh, Ithaar H; Porpiglia, Francesco; Mottrie, Alexandre; Autorino, Riccardo.

In: Minerva urologica e nefrologica = The Italian journal of urology and nephrology, 13.09.2019.

Research output: Contribution to journalArticle

Veccia, A, Dell'oglio, P, Antonelli, A, Minervini, A, Simone, G, Challacombe, B, Perdoná, S, Porter, J, Zhang, C, Capitanio, U, Sundaram, CP, Cacciamani, G, Aron, M, Anele, U, Hampton, LJ, Simeone, C, de Naeyer, G, Bradshawh, A, Mari, A, Campi, R, Carini, M, Fiori, C, Gallucci, M, Jacobsohn, K, Eun, D, Lau, C, Kaouk, J, Derweesh, IH, Porpiglia, F, Mottrie, A & Autorino, R 2019, 'Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses', Minerva urologica e nefrologica = The Italian journal of urology and nephrology. https://doi.org/10.23736/S0393-2249.19.03583-5
Veccia, Alessandro ; Dell'oglio, Paolo ; Antonelli, Alessandro ; Minervini, Andrea ; Simone, Giuseppe ; Challacombe, Benjamin ; Perdoná, Sisto ; Porter, James ; Zhang, Chao ; Capitanio, Umberto ; Sundaram, Chandru P ; Cacciamani, Giovanni ; Aron, Monish ; Anele, Uzoma ; Hampton, Lance J ; Simeone, Claudio ; de Naeyer, Geert ; Bradshawh, Aaron ; Mari, Andrea ; Campi, Riccardo ; Carini, Marco ; Fiori, Cristian ; Gallucci, Michele ; Jacobsohn, Ken ; Eun, Daniel ; Lau, Clayton ; Kaouk, Jad ; Derweesh, Ithaar H ; Porpiglia, Francesco ; Mottrie, Alexandre ; Autorino, Riccardo. / Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses. In: Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2019.
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author = "Alessandro Veccia and Paolo Dell'oglio and Alessandro Antonelli and Andrea Minervini and Giuseppe Simone and Benjamin Challacombe and Sisto Perdon{\'a} and James Porter and Chao Zhang and Umberto Capitanio and Sundaram, {Chandru P} and Giovanni Cacciamani and Monish Aron and Uzoma Anele and Hampton, {Lance J} and Claudio Simeone and {de Naeyer}, Geert and Aaron Bradshawh and Andrea Mari and Riccardo Campi and Marco Carini and Cristian Fiori and Michele Gallucci and Ken Jacobsohn and Daniel Eun and Clayton Lau and Jad Kaouk and Derweesh, {Ithaar H} and Francesco Porpiglia and Alexandre Mottrie and Riccardo Autorino",
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TY - JOUR

T1 - Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses

AU - Veccia, Alessandro

AU - Dell'oglio, Paolo

AU - Antonelli, Alessandro

AU - Minervini, Andrea

AU - Simone, Giuseppe

AU - Challacombe, Benjamin

AU - Perdoná, Sisto

AU - Porter, James

AU - Zhang, Chao

AU - Capitanio, Umberto

AU - Sundaram, Chandru P

AU - Cacciamani, Giovanni

AU - Aron, Monish

AU - Anele, Uzoma

AU - Hampton, Lance J

AU - Simeone, Claudio

AU - de Naeyer, Geert

AU - Bradshawh, Aaron

AU - Mari, Andrea

AU - Campi, Riccardo

AU - Carini, Marco

AU - Fiori, Cristian

AU - Gallucci, Michele

AU - Jacobsohn, Ken

AU - Eun, Daniel

AU - Lau, Clayton

AU - Kaouk, Jad

AU - Derweesh, Ithaar H

AU - Porpiglia, Francesco

AU - Mottrie, Alexandre

AU - Autorino, Riccardo

PY - 2019/9/13

Y1 - 2019/9/13

N2 - BACKGROUND: Recent evidence suggests that the "oldest old" patients might benefit of partial nephrectomy (PN), but decisionmaking for this subset of patients is still controversial. Aim of this study is to compare outcomes of robotic partial (RPN) or radical nephrectomy (RRN) for large renal masses in patients older than 65 years.METHODS: We identified 417 ≥65 years old patients who underwent robotic radical nephrectomy (RRN) or RPN for cT1b or ≥cT2 renal mass at 17 high volume centers. Propensity score match analysis was performed adjusting for age, ASA≥3, pre-operative eGFR, and clinical tumor size. Predictors of complications, functional and oncological outcomes were evaluated in multivariable logistic and Cox regression models.RESULTS: After propensity score analysis, 73 patients in the RPN group were matched with 74 in the RRN group. R.E.N.A.L. Score (9.6±1.7 vs 8.6±1.7; p<0.001), and high complexity (56 vs 15%; p=0.001) were higher in the RRN. Estimated blood loss was higher in the RPN group (200 vs 100 mL; p<0.001). RPN showed higher rate of overall complications (38 vs 23%; p=0.05), but not major complications (p=0.678). At last follow-up, RPN group showed better functional outcomes both in eGFR (55.4±22.6 vs 45.7±15.7 mL/min; p=0.016) and lower eGFR variation (9.7 vs 23.0 mL/min; p<0.001). The procedure type was not associated with recurrence free survival (RFS) (HR: 0.47; p=0.152) and overall mortality (OM) (0.22; p=0.084).CONCLUSIONS: RPN In elderly patientswith large renal masses provides RPN offers acceptable surgical, and oncological outcomes allowing better functional preservation relative to RRN. The decision to undergo RPN in this subset of patients should be tailored on a case by case basis.

AB - BACKGROUND: Recent evidence suggests that the "oldest old" patients might benefit of partial nephrectomy (PN), but decisionmaking for this subset of patients is still controversial. Aim of this study is to compare outcomes of robotic partial (RPN) or radical nephrectomy (RRN) for large renal masses in patients older than 65 years.METHODS: We identified 417 ≥65 years old patients who underwent robotic radical nephrectomy (RRN) or RPN for cT1b or ≥cT2 renal mass at 17 high volume centers. Propensity score match analysis was performed adjusting for age, ASA≥3, pre-operative eGFR, and clinical tumor size. Predictors of complications, functional and oncological outcomes were evaluated in multivariable logistic and Cox regression models.RESULTS: After propensity score analysis, 73 patients in the RPN group were matched with 74 in the RRN group. R.E.N.A.L. Score (9.6±1.7 vs 8.6±1.7; p<0.001), and high complexity (56 vs 15%; p=0.001) were higher in the RRN. Estimated blood loss was higher in the RPN group (200 vs 100 mL; p<0.001). RPN showed higher rate of overall complications (38 vs 23%; p=0.05), but not major complications (p=0.678). At last follow-up, RPN group showed better functional outcomes both in eGFR (55.4±22.6 vs 45.7±15.7 mL/min; p=0.016) and lower eGFR variation (9.7 vs 23.0 mL/min; p<0.001). The procedure type was not associated with recurrence free survival (RFS) (HR: 0.47; p=0.152) and overall mortality (OM) (0.22; p=0.084).CONCLUSIONS: RPN In elderly patientswith large renal masses provides RPN offers acceptable surgical, and oncological outcomes allowing better functional preservation relative to RRN. The decision to undergo RPN in this subset of patients should be tailored on a case by case basis.

U2 - 10.23736/S0393-2249.19.03583-5

DO - 10.23736/S0393-2249.19.03583-5

M3 - Article

C2 - 31527571

JO - Minerva Urologica e Nefrologica

JF - Minerva Urologica e Nefrologica

SN - 0393-2249

ER -