Outcomes of partial versus radical nephrectomy in octogenarian patients: results from the RESURGE project
An increasing number of localized kidney cancers is 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 is to compare surgical, functional and oncological outcomes of par-tial (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).
A retrospective analysis of the RESURGE dataset was performed, focusing on patients ≥80 years. A PN group and a RN group were identified. Differences between the two groups were measured by Pearson chi-square test and Mann-Whitney u-test. 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 relation-ship with cancer specific survival (CSS).
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, p=0.008). 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 mor-bidity 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; Clavien≥3 post-operative 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).
Indication to PN in octogenarian is mainly driven by tumor&[prime]s features. PN provides better preservation of renal function without increasing perioperative morbidity. Cancer specific mortality is not negligible, despite patients&[prime] age. After accounting for confounders and competitive causes of mortality, PN and younger age are related to lower cancer-specific mortality.