To analyze the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in octogenarian patients.
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.
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=0.0084), had larger tumor size (p<0.0001) and higher clinical stage (p<0.001). 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=0.04). The rate of significant (>25%) decrease of eGFR in PN and RN was 18% vs 59% at 1 month, and 23% vs 65% at 6 months (p values<0.0001). After a median follow up time of 39 months, 161 patients (31%) died, of whom 105 (20%) due to renal cancer.
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.
Urology. 2019 Mar 23 [Epub ahead of print]
Alessandro Antonelli, Alessandro Veccia, Nicola Pavan, Carmen Mir, Alberto Breda, Toshio Takagi, Koon H Rha, Tobias Maurer, Chao Zhang, Jean-Alexandre Long, Cosimo De Nunzio, Estevão Lima, Matteo Ferro, Salvatore Micali, Giuseppe Quarto, Estefania Linares, Antonio Celia, Luigi Schips, Pierluigi Bove, Alessandro Larcher, Cristian Fiori, Alexandre Mottrie, Ahmet Bindayi, Carlo Trombetta, Tommaso Silvestri, Joan Palou, Oscar Rodriguez Faba, Kazunari Tanabe, Bo Yang, Gaelle Fiard, Andrea Tubaro, Joao Nuno Torres, Ottavio De Cobelli, Luigi Bevilacqua, Roberto Castellucci, Andrew Tracey, Lance J Hampton, Francesco Montorsi, Sisto Perdonà, Claudio Simeone, Carlotta Palumbo, Umberto Capitanio, Ithaar Derweesh, Francesco Porpiglia, Riccardo Autorino
Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy, Department of Medical and Surgical Specialties, Rediological Science, and Public Health, University of Brescia, Italy., Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy, Department of Medical and Surgical Specialties, Rediological Science, and Public Health, University of Brescia, Italy; Division of Urology, VCU Health, Richmond, VA, USA., Department of Urology, Cattinara Hospital, University of Trieste, Italy., Department of Urology, Instituto Valenciano de Oncología Foundation, Valencia, Spain., Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain., Department of Urology, Tokyo Women's Medical University, Tokyo, Japan., Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea., Department of Urology, Medical Center rechts der Isar, Technical University of Munich, Munich, Germany., Department of Urology, Changhai Hospital, Shanghai, China., Department of Urology and Kidney Transplantation, Grenoble University Hospital, Grenoble, France., Department of Urology, Hospital "Sant' Andrea", Sapienza University, Rome, Italy., Department of Urology, Hospital de Braga, Braga, Portugal., Department of Urology, European Institute of Oncology, Milan, Italy., Department of Urology, University of Modena and Reggio Emilia, Modena, Italy., Uro-Gynecological Department, Fondazione "G. Pascale" IRCCS, Naples, Italy., Department of Urology. Hospital Universitario La Paz. Madrid. Spain., Department of Urology, San Bassiano Hospital, Bassano Del Grappa, Italy., Department of Urology, SS. Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy., Department of Urology, San Carlo di Nancy, Tor Vergata University, Rome, Italy., Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy., Department of Urology, OLV Ziekenhuis, Aalst, Belgium., Department of Urology, UCSD Health System, La Jolla, CA, USA., Division of Urology, VCU Health, Richmond, VA, USA., Division of Urology, VCU Health, Richmond, VA, USA. Electronic address: .