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.
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.
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).
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.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2019 Sep 13 [Epub ahead of print]
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 Campi, Marco Carini, Cristian Fiori, Michele Gallucci, Ken Jacobsohn, Daniel Eun, Clayton Lau, Jad Kaouk, Ithaar H Derweesh, Francesco Porpiglia, Alexandre Mottrie, Riccardo Autorino
Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA., ORSI Academy, Melle, and Department of Urology, OLV Ziekenhuis, Aalst, Belgium., Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy., MRC Centre for Transplantation, NIHR Biomedical Research Centre, Guy's Hospital, King's College, London, UK., Unit of Urology, IRCCS Fondazione "G. Pascale", Naples, Italy., Swedish Urology Group, Swedish Medical Center, Seattle, WA, USA., Department of Urology, Changhai Hospital, Shanghai Shi, China., Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy., Department of Urology, Indiana University Health, Indianapolis, IN, USA., Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA., Department of Urology, UC San Diego Health System, La Jolla, CA, USA., Department of Urology, University of Turin, "San Luigi Gonzaga" Hospital, Turin, Italy., Department of Urology, Medical College Wisconsin, Milwaukee, WI, USA., Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA., Division of Urology, City of Hope National Medical Center, Duarte, CA, USA., Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA - .