Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge)

Published on Jul 1, 2019in Urology1.924
· DOI :10.1016/J.UROLOGY.2019.03.009
Alessandro Antonelli30
Estimated H-index: 30
(University of Brescia),
Alessandro Veccia10
Estimated H-index: 10
(University of Brescia)
+ 42 AuthorsRiccardo Autorino68
Estimated H-index: 68
Sources
Abstract
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 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.
References27
Newest
#1Umberto Capitanio (UniSR: Vita-Salute San Raffaele University)H-Index: 62
#2Karim Bensalah (University of Rennes)H-Index: 64
Last. Paul Russo (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 102
view all 10 authors...
Abstract Context Despite the improvement in renal cell carcinoma (RCC) diagnosis and management observed during the last 2 decades, RCC remains one of the most lethal urological malignancies. With the expansion of routine imaging for many disorders, an increasing number of patients who harbour RCC are identified incidentally. Objective To summarise and compare RCC incidence and mortality rates, analyse the magnitude of risk factors, and interpret these epidemiological observations in the context...
275 CitationsSource
#1Victoria White (Deakin University)H-Index: 51
#2David J. T. Marco (University of Melbourne)H-Index: 6
Last. Susan J. Jordan (UQ: University of Queensland)H-Index: 30
view all 10 authors...
To describe the use of partial nephrectomy (PN) for patients with stage T1a renal cell carcinoma (RCC) by age group ( All adults diagnosed with RCC in 2012 and 2013 were identified through population-based cancer registries in the Australian states of Queensland and Victoria. For each patient, research assistants extracted patient, tumour and treatment data from medical records. Percentages treated by PN were determined for the two age groups. Multivariable logistic regression analyses examined ...
3 CitationsSource
#1Alessandro Antonelli (University of Brescia)H-Index: 30
#2Andrea Mari (UniFI: University of Florence)H-Index: 31
Last. Filiberto ZattoniH-Index: 28
view all 35 authors...
Purpose: We sought to determine the predictors of short-term and long-term renal function impairment after partial nephrectomy.Materials and Methods: Clinical data on 769 consecutive patients who underwent partial nephrectomy were prospectively recorded at a total of 19 urological Italian centers from 2009 to 2012 in the RECORd 1 (Italian Registry of Conservative Renal Surgery) Project. We extracted clinical data on 708 of these patients who were alive, free of recurrent disease and with a minim...
15 CitationsSource
#1Gladell P. Paner (U of C: University of Chicago)H-Index: 39
#2Walter M. Stadler (U of C: University of Chicago)H-Index: 104
Last. Mahul B. Amin (UTHSC: University of Tennessee Health Science Center)H-Index: 45
view all 6 authors...
Abstract The Tumor-Node-Metastasis (TNM) classification on cancer staging, jointly developed by the American Joint Commission on Cancer (AJCC) and the Union for International Cancer Control (UICC), has been updated to its 8th edition with two contemporaneous versions published by the AJCC and UICC. While the goal of the AJCC and UICC is to have identical TNM staging systems, differences exist between these two publications including in the staging of urologic cancers. Among several new facets in...
167 CitationsSource
#1Marco Bandini (UniSR: Vita-Salute San Raffaele University)H-Index: 24
#2Michele Marchioni (UdeM: Université de Montréal)H-Index: 15
Last. Pierre I. KarakiewiczH-Index: 116
view all 12 authors...
Introduction: Contemporary data regarding the effect of age, especially in elderly patients, on cancer-specific mortality (CSM) for pT1a renal cell carcinoma (RCC) are lacking. The objective of the current study is to evaluate CSM in a large population-based cohort of surgically treated pT1a RCC patients according to age groups. Methods: Within the Surveillance Epidemiology and End Results database (2000‒2013), we identified 37 121 pT1a RCC patients who underwent either partial or radical nephre...
9 CitationsSource
#1Nicola PavanH-Index: 14
#2Tommaso SilvestriH-Index: 6
Last. Riccardo AutorinoH-Index: 68
view all 51 authors...
1 CitationsSource
1 CitationsSource
#1Dominic H. TangH-Index: 13
#2Jude NawloH-Index: 1
Last. Philippe E. SpiessH-Index: 35
view all 8 authors...
Abstract Background We reviewed the outcomes for an octogenarian population to investigate whether active surveillance (AS) provides comparable survival to partial nephrectomy (PN) or radical nephrectomy (RN). Patients and Methods Data were collected from 115 octogenarian patients referred for management of renal masses at Moffitt Cancer Center from 2000 to 2013. Patients were treated with AS, PN, or RN. Univariable and multivariable Cox regression models measured the association between managem...
15 CitationsSource
#1Emil Scosyrev (URMC: University of Rochester Medical Center)H-Index: 3
#2Edward M. Messing (URMC: University of Rochester Medical Center)H-Index: 83
Last. Hendrik Van Poppel (Katholieke Universiteit Leuven)H-Index: 82
view all 4 authors...
Abstract Background In the European Organization for Research and Treatment of Cancer (EORTC) randomized trial 30904, nephron-sparing surgery (NSS) reduced the risk of renal dysfunction compared with radical nephrectomy (RN); however, overall survival was better in the RN arm. Objective To determine whether treatment effect on the risk of renal dysfunction and all-cause mortality differed in magnitude across levels of baseline variables. Design, setting, and participants This was an exploratory ...
6 CitationsSource
#1Daniel C. Wang (State University of New York Upstate Medical University)H-Index: 1
#2Kyle Plante (State University of New York Upstate Medical University)H-Index: 3
Last. Gennady Bratslavsky (State University of New York Upstate Medical University)H-Index: 21
view all 7 authors...
Abstract Purpose There is a paucity of data comparing effects of partial nephrectomy (PN) vs. radical nephrectomy (RN) on overall survival in young patients. In this study, the National Cancer Database was used to evaluate the survival outcomes of those treated with PN and RN, and influence of comorbidities on surgical treatment (PN vs. RN) in young patients while accounting for Charlson-Deyo Comorbidity Score (CDCS). Materials and methods Patients between 20 and 44 years old ( n = 9,849) surgic...
8 CitationsSource
Cited By3
Newest
#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...
10 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