AUA 2018: Outcomes of Partial Versus Radical Nephrectomy in Octogenarian Patients: Results from the RESURGE Project

San Francisco, CA ( An increasing number of localized kidney cancers are being diagnosed in elderly people, raising the issue of which is the optimal surgical management in this subset of patients. The aim of this study was to compare surgical, functional and oncological outcomes of partial (PN) versus radical nephrectomy (RN) in a multi-institutional cohort of elderly patients from 23 European, US and Asian Institutions (REnal SUrgery in the Elderly - RESURGE - project). 

For this purpose, a retrospective analysis of the RESURGE dataset was performed, focusing on patients 80 years and above. A PN group and a RN group were identified. A multivariable Fine and Gray competing risk analysis (including age, comorbidity, pathological tumor diameter, stage and grading and type of surgery) was used to assess the relationship with cancer specific survival (CSS). 

A total of 585 patients were included (mean age 82.8 2.5, range 80-94 years; 48% female) of whom 364 (62.2%) underwent RN and 221 (37.8%) PN. Patients of both groups showed similar features, except for older age in RN group (83.1 vs 82.4 years, p¼0.008). Baseline renal function was similar, with median value close to CKD3 limit (RN vs PN 58.7 vs 60.4 ml/min, p=0.836). RN group had larger, more advanced and aggressive tumors at clinical staging and final pathology. Open, laparoscopic and robotic approaches were used in 61%, 37%, 1% and 52%, 19% and 28% of RN and PN, respectively. Perioperative morbidity was similar in terms of blood loss (300 vs 352 cc, p=0.157) and complication rates (intra-operative 8.6% vs 11.5%, p=0.259; post-operative 25.8% vs 24.5%, p=0.716; Clavien3 postoperative 5.0% vs 5.8%, p=0.168). At 6 months after surgery PN showed higher residual renal function (eGFR 51.6 vs 39.7 ml/min, p=0.001). At a median follow-up time of 39 months, 20% of patients died due to renal cancer, 11% for unrelated causes. Competing-risk regression model showed that the factors independently related to CSS were age and type of surgery (subhazard ratios 1.13 and 0.44, p=0.026 and 0.052, respectively).

The authors concluded that Indication to PN in octogenarians is mainly driven by tumor features. PN provides better preservation of renal function without increasing perioperative morbidity. Cancer specific mortality is not negligible, despite patients age. After accounting for confounders and competitive causes of mortality, PN, and younger age are related to lower cancer-specific mortality.

Presented by: Carlotta Palumbo, University of Brescia, Italy
Co-Authors: Alessandro Antonelli, Maria Furlan, Brescia, Italy, Nicola Pavan, Trieste, Italy, Carmen Mir, Valencia, Spain, Alberto Breda, Barcelona, Spain, Estefania Linares, Madrid, Spain, Toshio Takagi, Tokyo, Japan, Koon Rha, Seoul, Korea, Republic of, Francesco Porpiglia, Turin, Italy, Tobias Maurer, Munich, Germany, Bo Yang, Shanghai, China, People's Republic of, Paolo Umari, Aslt, Belgium, Jean-Alexandre Long, Grenoble, France, Cosimo De Nunzio, Rome, Italy, Andrew Tracey, Richmond, VA, Matteo Ferro, Milan, Italy, Salvatore Micali, Modena, Italy, Estevão Lima, Braga, Portugal, Alfredo Aguilera, Madrid, Spain, Kazunari Tanabe, Tokyo, Japan, Ali Raheem, Seoul, Korea, Republic of, Riccardo Bertolo, Turin, Italy, Thomas Amiel, Munich, Germany, Chao Zang, Shanghai, China, People's Republic of, Gaelle Fiard, Grenoble, France, Andrea Tubaro, Rome, Italy, Ottavio De Cobelli, Milan, Italy, Luigi Bevilacqua, Modena, Italy, Joao Torres, Braga, Portugal, Pierluigi Bove, Rome, Italy, Luigi Schips, Roberto Castellucci, Chieti, Italy, Sisto Perdona, Giuseppe Quarto, Naples, Italy, Antonio Celia, Bernardino De Concilio, Bassano del Grappa, Italy, Carlo Trombetta, Tommaso Silvestri, Trieste, Italy, Alexandre Mottrie, Aslt, Belgium, Joan Palou, Oscar Rodriguez Faba, Barcelona, Spain, Umberto Capitanio, Alessandro Larcher, Francesco Montorsi, Milan, Italy, Ithaar Derweesh, Ahmet Bindayi, Zachary Hamilton, San Diego, CA, Riccardo Autorino, Richmond, VA

Written by:  Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA