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Partial vs Radical Nephrectomy for T1-T2 Renal Masses in the Elderly: Comparison of Complications, Renal Function, and Oncologic Outcomes

Published:November 23, 2016DOI:https://doi.org/10.1016/j.urology.2016.10.047

      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.
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      Linked Article

      • Reply by the Authors
        UrologyVol. 103
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          We 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.
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      • 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
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          The 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.
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