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 journalArticlepeer-review


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.


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