Between 2001 and 2015, 707 nephrectomies (RN and PN) were performed and analyzed for the purpose of this study. 98 (14%) elderly patients were identified, older than 75 years at the time of surgery. Baseline patient characteristics, Charlson comorbidity index (CCI), preoperative renal function, RENAL nephrometry score, type of surgery (RN vs PN) and surgical approach was collected. Surgical outcomes between RN and PN ere compared. Study outcomes were renal function at follow-up measured by changes in eGFR before and after surgery at 1-6 months and >12 months.
At a median follow-up of 62 months (IQR 26-109), 60 patients were alive. Median age at surgery was 77 (IQR 76-81) with median CCI of 2 (range 1-7). Tumor characteristics showed smaller tumors undergoing PN (50 mm vs 27 mm, p=0.02) with no differences on RENAL score (7 vs 5, p=0.12) for RN and PN, respectively. Out of 98 patients, 84 (86%) underwent RN while 14 (14%) had PN. Surgical approach was 54 laparoscopic (49 RN, 5 PN) and 44 open (35 RN, 9 PN). Shorter operative time was observed in RN group, 130 min vs 165 min (p=0.03). Mean hospital stay was 5 (IQR 3-6) vs. 3 (IQR 3-4) days for RN and PN (p=0.16), with 7% and 14% transfusion rate (p=0.14), respectively. Overall 29 (30%) perioperative complications were recorded (30% RN and 29% PN) (p=0.91). High-grade complications (Clavien >3) were described in 6 RN and none of PN. Preoperative mean eGFR was 63 ml/min/1.73m2 and mean serum Cr 1.06 mg/dl (SD+0,26). Renal functional outcomes were postoperative eGFR of 60 at 1-6m follow-up and 52 eGFR at >12m. When comparing RN and PN, eGFR at last follow-up was 46 and 53, respectively (p=0.41).
In conclusion, RN had shorter operative time than PN, but with similar perioperative complication rates. No differences in renal function outcomes were observed between RN and PN in elderly patients. This information should be known by both surgeons and patients alike, before deciding on the operative plan.
Presented by: Luis M. Quintana
Affiliation: University Hospital La Paz, Madrid, Spain
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal