Objective
To compare outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in patients
65 years and older.
Materials and Methods
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 estimated glomerular filtration rate (eGFR) and freedom from eGFR< 45 mL/min/1.73 m2 were analyzed. Multivariate Cox proportional hazard models for overall survival and
cancer-specific survival were analyzed.
Results
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 years vs 71.9 years, P < .001), had lower American Society of Anesthesiologists scores (2.6 vs 2.8, P = .001), smaller tumors (tumor diameter 2.8 cm vs 5.0 cm, P < .001), and lower proportion of renal cell carcinoma (76.7% vs 87.4%, P < .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 < .001) at last follow-up. Overall survival and cancer-specific survival were equivalent
between modalities.
Conclusion
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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Renal cell carcinoma: prognostic significance of incidentally detected tumors.J Urol. 2000; 163: 426-430
- Projections of the Size and Composition of the US Population: 2014 to 2060.U.S. Census Bureau, Washington, DC2015: 25-1143
- Surgical risk factors, morbidity, and mortality in elderly patients.J Am Coll Surg. 2006; 203: 865-877
- Comorbidities and causes of death in the management of localized T1a kidney cancer.Int J Urol. 2014; 21: 1086-1092
- The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications.Eur Urol. 2010; 57: 214-222
- Nephron-sparing surgery is equally effective to radical nephrectomy for T1BN0M0 renal cell carcinoma: a population-based assessment.Urology. 2010; 75: 271-275
- Comparison between open partial and radical nephrectomy for renal tumours: perioperative outcome and health-related quality of life.Eur Urol. 2007; 51: 614-620
- Complications after radical and partial nephrectomy as a function of age.J Urol. 2010; 183: 1725-1730
- Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit.BJU Int. 2016; 117: 62-71
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Guideline for management of the clinical T1 renal mass.J Urol. 2009; 182: 1271-1279
- Morbidity of urologic surgical procedures: an analysis of rates, risk factors, and outcomes.Urology. 2015; 85: 552-559
- Management of renal masses and localized renal cancer.J Urol. 2016; 196 (Prepared by the JHU Evidence-based Practice Center under Contract No. HHSA290201200007I. Rockville, MD: Agency for Healthcare Research and Quality): 989-999
- Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function.Eur Urol. 2015; 67: 683-689
- Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.N Engl J Med. 2004; 351: 1296-1305
- A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma.Eur Urol. 2011; 59: 543-552
- Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904.Eur Urol. 2014; 65: 372-377
- Chronic kidney disease due to surgical removal of nephrons: relative rates of progression and survival.J Urol. 2014; 192: 1057-1062
- Surgically induced chronic kidney disease may be associated with a lower risk of progression and mortality than medical chronic kidney disease.J Urol. 2013; 189: 1649-1655
- The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons. A community-based, longitudinal study.J Intern Med. 2009; 265: 288-295
- Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer.JAMA. 2012; 307: 1629-1635
- Preoperative predictors of malignancy and unfavorable pathology for clinical T1a tumors treated with partial nephrectomy: a multi-institutional analysis.Urol Oncol. 2015; 33: 112.e9-112.e14
- Evaluation of renal mass biopsy risk stratification algorithm for robotic partial nephrectomy—could a biopsy have guided management?.J Urol. 2014; 192: 1337-1342
- Prospective evaluation of (99m)Tc-sestamibi SPECT/CT for the diagnosis of renal oncocytomas and hybrid oncocytic/chromophobe tumors.Eur Urol. 2016; 69: 413-416
Article info
Publication history
Published online: November 23, 2016
Accepted:
October 3,
2016
Received:
August 26,
2016
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: This work is supported by the National Institute on Aging [RFA-AG-15-009], the American Federation for Aging Research, and The John A. Hartford Foundation.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Reply by the AuthorsUrologyVol. 103
- PreviewWe are pleased that our recent publication was the source of discussion at your journal club.1 For the question of tumor sizes listed in table 1, the values listed are medians and interquartile ranges. In other words, “the upper range” listed is actually the 75th percentile value. In fact, the absolute upper limit was 14.5 cm for the partial nephrectomy group and 16 cm for the radical nephrectomy group. For the issue of the survival curves in figure 2, the stages indicated are clinical stage. Some clinical T2 tumors were upstaged to pT3 disease at final pathology, accounting for the higher number at risk in figure 2.
- Full-Text
- Preview
- Re: An et al.: Partial vs Radical Nephrectomy for T1-T2 Renal Masses in the Elderly: Comparison of Complications, Renal Function, and Oncologic Outcomes (Urology 2017;100:151-157)UrologyVol. 103
- PreviewThe article by An et al,1 recently published in Urology, was reviewed by us for our journal club and we noticed some data in the tables and figures that seemed discordant. The authors mention that survival analysis was limited to patients with renal cell cancer and cancer-specific survival was calculated from the time of surgery to death from kidney cancer. There seems to be a mismatch in the data presented in table 1 and figure 2.
- Full-Text
- Preview
