To compare outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in patients 65 years and older.
Our institutional renal mass registry was queried for patients 65 and older with solitary cT1-T2 renal mass resected by PN or RN. Clinicopathologic features and perioperative outcomes were compared between groups. Renal function outcomes measured by change in eGFR and freedom from eGFR < 45 ml/minute/1.73m(2) were analyzed. Multvariate Cox proportional hazards models for overall survival (OS) and cancer-specific survival (CSS) were analyzed.
Overall, 787 patients met inclusion criteria. Of these, 437 (55.5%) underwent PN and 350 (44.5%) underwent RN. Median follow-up was 36 months. Patients in the PN cohort were younger (median age 70.3 vs. 71.9 years, p<0.001), had lower ASA scores (2.6 vs. 2.8, p=0.001), smaller tumors (tumor diameter 2.8 vs. 5.0cm, p<0.001), and lower proportion of RCC (76.7 vs. 87.4%, p<0.001). Perioperative outcomes were similar between PN and RN groups as were complications (37.8 vs 38.9%). Estimated change in eGFR was less in PN vs. RN (6.4 vs. 19.7, p<0.001) at last follow-up. OS and CSS were equivalent between modalities.
Because the renal functional benefit of PN is realized over many years and the procedure has a higher historical complication rate than RN, some suspected elderly patients might benefit more from RN over PN. However, these data suggest that elderly patients are not harmed and may potentially benefit from PN. Age alone should not be a contraindication to nephron-sparing surgery.
Urology. 2016 Jan 23 [Epub ahead of print]
Julie Y An, Mark W Ball, Michael A Gorin, Jiwon J Hong, Michael H Johnson, Christian P Pavlovich, Mohamad E Allaf, Phillip M Pierorazio
The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD., The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: .