Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge)
Alessandro Antonelli
,
Alessandro Veccia
,
Nicola Pavan
,
Carmen Mir
,
Alberto Breda
,
Toshio Takagi
,
Koon Rha
,
Tobias Maurer
,
Chao Zhang
(1)
,
Jean-Alexandre Long
(2)
,
Cosimo de Nunzio
(3)
,
Estevão Lima
,
Matteo Ferro
,
Salvatore Micali
,
Giuseppe Quarto
,
Estefania Linares
,
Antonio Celia
,
Luigi Schips
(4)
,
Pierluigi Bove
,
Alessandro Larcher
(5)
,
Cristian Fiori
,
Alexandre Mottrie
(6)
,
Ahmet Bindayi
,
Carlo Trombetta
,
Tommaso Silvestri
,
Joan Palou
(7)
,
Oscar Rodriguez Faba
,
Kazunari Tanabe
,
Bo Yang
(8)
,
Gaelle Fiard
(2)
,
Andrea Tubaro
(9)
,
Joao Nuno Torres
,
Ottavio de Cobelli
,
Luigi Bevilacqua
,
Roberto Castellucci
,
Andrew Tracey
,
Lance Hampton
,
Francesco Montorsi
(10)
,
Sisto Perdonà
(11)
,
Claudio Simeone
(12)
,
Carlo Palumbo
,
Umberto Capitanio
(10)
,
Ithaar Derweesh
,
Francesco Porpiglia
,
Riccardo Autorino
1
CAU -
China Agricultural University
2 TIMC-IMAG-GMCAO - Gestes Medico-chirurgicaux Assistés par Ordinateur
3 Department of Urology
4 Department of Urology
5 Cancer Prognostics and Health Outcomes Unit
6 OLVG Hospital
7 servicio de urologia
8 IIE - Institute of Information Engineering [Beijing]
9 Department of Clinical and Molecular Medicine
10 Department of urology
11 Department of Endocrinology and Medical Oncology, Genitourinary Cancer Section
12 chair and department of urology
2 TIMC-IMAG-GMCAO - Gestes Medico-chirurgicaux Assistés par Ordinateur
3 Department of Urology
4 Department of Urology
5 Cancer Prognostics and Health Outcomes Unit
6 OLVG Hospital
7 servicio de urologia
8 IIE - Institute of Information Engineering [Beijing]
9 Department of Clinical and Molecular Medicine
10 Department of urology
11 Department of Endocrinology and Medical Oncology, Genitourinary Cancer Section
12 chair and department of urology
Alessandro Antonelli
- Fonction : Auteur
Alessandro Veccia
- Fonction : Auteur
Nicola Pavan
- Fonction : Auteur
Carmen Mir
- Fonction : Auteur
Alberto Breda
- Fonction : Auteur
Toshio Takagi
- Fonction : Auteur
Koon Rha
- Fonction : Auteur
Tobias Maurer
- Fonction : Auteur
Chao Zhang
- Fonction : Auteur
- PersonId : 771954
- ORCID : 0000-0002-7167-0840
Estevão Lima
- Fonction : Auteur
Matteo Ferro
- Fonction : Auteur
Salvatore Micali
- Fonction : Auteur
Giuseppe Quarto
- Fonction : Auteur
Estefania Linares
- Fonction : Auteur
Antonio Celia
- Fonction : Auteur
Pierluigi Bove
- Fonction : Auteur
Cristian Fiori
- Fonction : Auteur
Ahmet Bindayi
- Fonction : Auteur
Carlo Trombetta
- Fonction : Auteur
Tommaso Silvestri
- Fonction : Auteur
Oscar Rodriguez Faba
- Fonction : Auteur
Kazunari Tanabe
- Fonction : Auteur
Joao Nuno Torres
- Fonction : Auteur
Ottavio de Cobelli
- Fonction : Auteur
Luigi Bevilacqua
- Fonction : Auteur
Roberto Castellucci
- Fonction : Auteur
Andrew Tracey
- Fonction : Auteur
Lance Hampton
- Fonction : Auteur
Carlo Palumbo
- Fonction : Auteur
Ithaar Derweesh
- Fonction : Auteur
Francesco Porpiglia
- Fonction : Auteur
Riccardo Autorino
- Fonction : Auteur
Résumé
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.