Surgical treatment for renal masses in the elderly: analysis of oncological, surgical and functional outcomes

Vol. 45 (3): 531-540, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0310


ORIGINAL ARTICLE

Slawomir Poletajew 1, Piotr Zapała 1, Bartlomiej Kopczyński 1, Lukasz Białek 1, Sylwia Bender 1, Tomasz Mutrynowski 1, Mateusz Nowak 1, Julia Mróz 1, Grzegorz Pędzisz 1, Bartosz Dybowski 1, Piotr Radziszewski 1
1 Department of Urology, Medical University of Warsaw, Warsaw, Poland

ABSTRACT

Purpose: Radical treatment in elderly patients with renal tumor remains debatable due to uncertainties regarding the risk of surgical complications, risk of end-stage renal disease (ESRD) and survival benefit. The aim of the study was to assess outcomes of radical treatment for renal cancer in elderly patients.
Materials and Methods: This retrospective analysis enrolled 507 consecutive patients treated with partial or radical nephrectomy due to renal mass. Patients with upfront metastatic disease (n=46) and patients lost to follow-up (n=110) were excluded from the analysis. Surgical, functional (screen for ESRD development) and survival outcomes were analyzed in patients aged >75 years in comparison to younger individuals.
Results: The analyzed group included 55 elderly patients and 296 younger controls. Within the cohort a total of 148 and 203 patients underwent radical and partial nephrectomies respectively. The rate of surgical complications, including grade >3 Clavien- Dindo complications, did not differ between groups (3.6% vs. 4.4%, p=0.63). Median length of hospital stay was equal in both groups (7 days). During a follow-up (median 51.9 months, no difference between groups), ESRD occurred in 3.4% of controls and was not reported in elderly group (p=0.37). Younger patients demonstrated a statistically significant advantage in both overall survival and cancer-specific survival over elderly patients (OS 94.6% vs. 87% p=0.036, CSS 97.3% vs. 89.1% p=0.0008).
Conclusions: Surgical treatment in elderly patients with renal tumor is as safe as in younger individuals and does not increase the risk of ESRD. However, cancer specific survival among these patients remains shorter than in younger patients.

Keywords: Kidney Neoplasms; Survival; Delayed Graft Function

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