Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group

Published on Sep 15, 2020in European urology focus4.827
· DOI :10.1016/J.EUF.2019.02.010
Ahmet Bindayi8
Estimated H-index: 8
(UCSD: University of California, San Diego),
Riccardo Autorino68
Estimated H-index: 68
(VCU: Virginia Commonwealth University)
+ 34 AuthorsIthaar H. Derweesh43
Estimated H-index: 43
(UCSD: University of California, San Diego)
Sources
Abstract
Abstract Background Partial nephrectomy (PN) in elderly patients is underutilized with concerns regarding risk of complications and potential for poor outcomes. Objective To evaluate quality and functional outcomes of PN in patients >75 yr using trifecta as a composite outcome of surgical quality. Design, setting, and participants Multicenter retrospective analysis of 653 patients aged >75 yr who underwent PN (REnal SURGery in Elderly [RESURGE] Group). Intervention PN. Outcome measurements and statistical analysis Primary outcome was achievement of trifecta (negative margin, no major [Clavien ≥3] urological complications, and ≥90% estimated glomerular filtration rate [eGFR] recovery). Secondary outcomes included chronic kidney disease (CKD) stage III and CKD upstaging. Multivariable analysis (MVA) was used to assess variables for achieving trifecta and functional outcomes. Kaplan-Meier survival analysis (KMA) was used to calculate renal functional outcomes. Results and limitations We analyzed 653 patients (mean age 78.4 yr, median follow-up 33 mo; 382 open, 157 laparoscopic, and 114 robotic). Trifecta rate was 40.4% (n = 264). Trifecta patients had less transfusion (p  Conclusions PN in elderly patients can be performed with acceptable quality outcomes. Trifecta was associated with decreased tumor complexity and improved functional preservation. Patient summary We looked at quality outcomes after partial nephrectomy in elderly patients. Acceptable quality outcomes were achieved, measured by a composite outcome called trifecta, whose achievement was associated with improved kidney functional preservation.
References30
Newest
#1Mihai Dorin Vartolomei (IEO: European Institute of Oncology)H-Index: 15
#2Deliu Victor Matei (Iuliu Hațieganu University of Medicine and Pharmacy)H-Index: 5
Last. Ottavio De CobelliH-Index: 31
view all 22 authors...
BACKGROUND: The aim of this study was to assess the long-term oncologic and functional outcomes in elderly patients having undergone robot-assisted partial nephrectomy (RAPN) for renal cancer (RC). METHODS: Sixty-one patients out of 323 who underwent RAPN for localized RC between July 2009 and March 2016 in our high-volume robotic surgery center (>800 procedures/year), had 70 years or more. Inclusion criteria of the study were age ≥70 years; pathological confirmed RCC and ASA Score ≤3. All patie...
8 CitationsSource
#1Freddie Bray (IARC: International Agency for Research on Cancer)H-Index: 18
#1Freddie Bray (IARC: International Agency for Research on Cancer)H-Index: 119
Last. Ahmedin Jemal (ACS: American Cancer Society)H-Index: 139
view all 6 authors...
This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer...
25.8k CitationsSource
#1Katherine E. FeroH-Index: 10
#2Zachary HamiltonH-Index: 9
Last. Ithaar H. DerweeshH-Index: 43
view all 5 authors...
OBJECTIVE: To describe the utilization and compare quality outcomes of partial nephrectomy (PN) for cT1a, cT1b and cT2a renal masses using a large national database. METHODS: We conducted a retrospective analysis of patients from the US National Cancer Database who underwent PN for cT1a/cT1b/T2a renal cell carcinoma between 2004 and 2013. We examined the use of PN over time and assessed quality indicators [positive surgical margin (PSM) and 30-day postoperative readmission rates]. Multivariable ...
18 CitationsSource
#1Steven C. Campbell (American Urological Association)H-Index: 71
#2Robert G. Uzzo (American Urological Association)H-Index: 18
Last. Philip Pierorazio (American Urological Association)H-Index: 4
view all 15 authors...
Purpose: This AUA Guideline focuses on evaluation/counseling and management of adult patients with clinically localized renal masses suspicious for cancer, including solid-enhancing tumors and Bosniak 3/4 complex-cystic lesions.Materials and Methods: Systematic review utilized research from the Agency for Healthcare Research and Quality and additional supplementation by the authors and consultant methodologists. Evidence-based statements were based on body of evidence strength Grade A/B/C (Stron...
484 CitationsSource
#1Sean P. Stroup (NMCSD: Naval Medical Center San Diego)H-Index: 20
#1Sean P. Stroup (NMCSD: Naval Medical Center San Diego)H-Index: 10
Last. Ithaar H. Derweesh (UCSD: University of California, San Diego)H-Index: 43
view all 14 authors...
Background We compared quality outcomes between transperitoneal (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN).
18 CitationsSource
#1Riccardo BertoloH-Index: 26
#2Homayoun Zargar (Royal Melbourne Hospital)H-Index: 10
Last. Francesco PorpigliaH-Index: 65
view all 8 authors...
The best method for assessing renal function after partial nephrectomy (PN) continues to be a matter of debate. Early studies evaluated kidney function by measuring serum creatinine (sCr) and/or the estimated glomerular filtration rate (eGFR), potentially underestimating the contribution of the contralateral kidney in masking alterations in renal function. Since then, researchers have studied the operated renal unit with the aid of nuclear renal scans (RS). However, taking into consideration the...
29 CitationsSource
: The NCCN Guidelines for Kidney Cancer provide multidisciplinary recommendations for the clinical management of patients with clear cell and non-clear cell renal carcinoma. These guidelines are developed by a multidisciplinary panel of leading experts from NCCN Member Institutions consisting of medical oncologists, hematologists and hematologic oncologists, radiation oncologists, urologists, and pathologists. The NCCN Guidelines are in continuous evolution and are updated annually or sometimes ...
301 CitationsSource
#1Hung-Jui Tan (UNC: University of North Carolina at Chapel Hill)H-Index: 20
#2Timothy J. Daskivich (Cedars-Sinai Medical Center)H-Index: 10
Last. Jim C. Hu (Cornell University)H-Index: 68
view all 6 authors...
Abstract Introduction The long-term benefits of nephron-sparing surgery for kidney cancer depend on patient health. Accordingly, we examined whether receipt of partial nephrectomy varied with baseline comorbidity or functionality among older adults with stage I kidney cancer. Materials and methods Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2000 to 2009, we identified patients treated with partial or radical nephrectomy for stage I kidney cancer. We examined treat...
11 CitationsSource
#1Maria Carmen MirH-Index: 19
#2Ithaar H. Derweesh (UC San Diego Health System)H-Index: 43
Last. Riccardo Autorino (Case Western Reserve University)H-Index: 68
view all 6 authors...
Abstract Background Partial nephrectomy (PN) is the reference standard of management for a cT1a renal mass. However, its role in the management of larger tumors (cT1b and cT2) is still under scrutiny. Objective To conduct a meta-analysis assessing functional, oncologic, and perioperative outcomes of PN and radical nephrectomy (RN) in the specific case of larger renal tumors (≥cT1b). The primary endpoint was an overall analysis of cT1b and cT2 masses. The secondary endpoint was a sensitivity anal...
143 CitationsSource
#1Simon P. Kim (Yale University)H-Index: 39
#2Cary P. Gross (Yale University)H-Index: 72
Last. Robert AbouassalyH-Index: 26
view all 10 authors...
Objective To assess the national trends in treatment of localized renal tumors among older patients with limited life expectancy. Materials and methods Using the National Cancer Database, we identified older patients (≥70 y) diagnosed with T1 renal cell carcinoma from 2002 to 2011. Primary outcome was the initial treatment—partial nephrectomy (PN), radical nephrectomy, EM, and ablation. Multivariable logistic regression analysis stratified by tumor size (<2, 2–3.9, or 4–7 cm) and age groups (70–...
18 CitationsSource
Cited By8
Newest
#1Matthew CrockettH-Index: 1
#2Simone GionaH-Index: 1
Last. Neil BarberH-Index: 23
view all 8 authors...
OBJECTIVE To externally validate the RENAL, PADUA and SPARE nephrometry scoring systems for use in retroperitoneal robot-assisted partial nephrectomy (RAPN). MATERIALS AND METHODS Nephrometry scores were calculated for 322 consecutive patients receiving retroperitoneal RAPN at a tertiary referral centre from 2017. Patients with multiple tumours were excluded. Scores were correlated with peri-operative outcomes, including the trifecta (warm ischaemia time <25 min, no peri-operative complications ...
Source
#1M.F. WunderleH-Index: 1
#2N. HärtelH-Index: 1
Last. Maximilian C. KriegmairH-Index: 13
view all 7 authors...
PURPOSE Comorbidities and frailty are determinants of surgical outcome. The aim of the study was to examine various measures of frailty and comorbidities in predicting postoperative outcome of partial nephrectomy (PN). METHODS We prospectively analyzed the frailty and comorbidity status of 150 patients undergoing PN between 2015 and 2018. Primary endpoint was the occurrence of major postoperative complications (MPC) and secondary endpoints were the failure of Trifecta achievement and the need fo...
1 CitationsSource
#1M T Walach (Heidelberg University)H-Index: 4
#2M.F. Wunderle (Heidelberg University)H-Index: 1
Last. Maximilian C. Kriegmair (Heidelberg University)H-Index: 13
view all 8 authors...
PURPOSE To examine frailty and comorbidity as predictors of outcome of nephron sparing surgery (NSS) and as decision tools for identifying candidates for active surveillance (AS) or tumor ablation (TA). METHODS Frailty and comorbidity were assessed using the modified frailty index of the Canadian Study of Health and Aging (11-CSHA) and the age-adjusted Charlson-Comorbidity Index (aaCCI) as well as albumin and the radiological skeletal-muscle-index (SMI) in a cohort of n = 447 patients with local...
Source
#1Paolo GonteroH-Index: 52
#2Andrea Mari (UniFI: University of Florence)H-Index: 31
Last. Andrea Minervini (UniFI: University of Florence)H-Index: 37
view all 24 authors...
BACKGROUND To investigate the perioperative and morbidity outcomes after partial nephrectomy (PN) in patients with short life expectancy (SLE) (≥95% 10-year expected mortality (10y-EM)), to assess the main predictors of outcomes in this population and to compare these results with those of a group at the opposite upper range with long LE (LLE, ≤5% 10y-EM) relying on a multicenter Italian prospective registry of kidney surgery (the RECORD 2 project). METHODS Clinical data of 4,325 patients underg...
1 CitationsSource
#2Ender Ozden (OMU: Ondokuz Mayıs University)H-Index: 14
Objective This study aims to compare renal functional outcomes of access techniques in patients who underwent off-clamp (Off-C) laparoscopic partial nephrectomy (LPN). Materials and methods Thirty-four Off-C LPNs in patients with functioning contralateral kidney from March 2011 to June 2018 were included in the study. Twenty-two patients underwent transperitoneal, 12 patients underwent retroperitoneal Off-C LPN. The primary outcome was glomerular filtration rate changes over time, postoperativel...
2 CitationsSource
#1Carlotta Palumbo (UdeM: Université de Montréal)H-Index: 6
#2Sophie Knipper (UdeM: Université de Montréal)H-Index: 11
Last. Pierre I. Karakiewicz (UdeM: Université de Montréal)H-Index: 116
view all 13 authors...
Abstract Objectives Historical data showed higher rates of morbidity following cytoreductive nephrectomy (CN) in older patients. We reassessed complication, failure to rescue (FTR) and mortality rates after CN in a contemporary cohort of older patients with metastatic renal cell carcinoma (mRCC). Materials and Methods From National Inpatient Sample (NIS) database (2008–2015), mRCC patients treated with CN were abstracted. Univariable and multivariable logistic regression models tested for the re...
6 CitationsSource
#1Alessandro Veccia (VCU: Virginia Commonwealth University)H-Index: 10
#2Paolo Dell'OglioH-Index: 28
Last. Riccardo Autorino (VCU: Virginia Commonwealth University)H-Index: 68
view all 31 authors...
BACKGROUND: Recent evidence suggests that the "oldest old" patients might benefit of partial nephrectomy (PN), but decision-making 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 RRN or RPN for cT1b or >/=cT2 renal mass at 17 high volume centers. Propensity score match analysis w...
5 CitationsSource
#1Alessandro Veccia (University of Brescia)H-Index: 10
#2Riccardo AutorinoH-Index: 68
Last. Alessandro Antonelli (University of Brescia)H-Index: 30
view all 7 authors...
Aim To provide a comprehensive analysis of the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for renal cell carcinoma (RCC) in older patients.
3 CitationsSource