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Titel:

Outcomes of minimally invasive partial nephrectomy among very elderly patients: report from the RESURGE collaborative international database.

Dokumenttyp:
Journal Article
Autor(en):
Larcher, Alessandro; Wallis, Christopher J D; Pavan, Nicola; Porpiglia, Francesco; Takagi, Toshio; Tanabe, Kazunari; Rha, Koon H; Raheem, Ali Abdel; Yang, Bo; Zang, Chao; Perdonà, Sisto; Quarto, Giuseppe; Maurer, Tobias; Amiel, Thomas; Schips, Luigi; Castellucci, Roberto; Crivellaro, Simone; Dobbs, Ryan; Baiamonte, Gianfranco; Celia, Antonio; De Concilio, Bernardino; Furlan, Maria; Lima, Estevão; Linares, Estefania; Micali, Salvatore; Amparore, Daniele; De Naeyer, Geert; Trombetta, Carlo; Hampto...     »
Abstract:
The aim of the study was to perform a comprehensive investigation of clinical outcomes of robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in elderly patients presenting with a renal mass. The REnal SURGery in Elderly (RESURGE) collaborative database was queried to identify patients aged 75 or older diagnosed with cT1-2 renal mass and treated with RAPN or LPN. Study outcomes were: overall complications (OC); warm ischemia time (WIT) and 6-month estimated glomerular filtration rate (eGFR); positive surgical margins (PSM), disease recurrence (REC), cancer-specific mortality (CSM) and other-cause mortality (OCM). Descriptive statistics, Kaplan-Meier, smoothed Poisson plots and logistic and linear regression models (MVA) were used. Overall, 216 patients were included in this analysis. OC rate was 34%, most of them being of low Clavien grade. Median WIT was 17 minutes and median 6-month eGFR was 54 ml/min/1.73 m2. PSM rate was 5%. After a median follow-up of 20 months, the 5-year rates of REC, CSM and OCM were 4, 4 and 5%, respectively. At MVA predicting perioperative morbidity, RAPN relative to LPN (odds ratio [OR] 0.33; p <0.0001) was associated with lower OC rate. At MVA predicting functional outcomes, RAPN relative to LPN was associated with shorter WIT (estimate [EST] -4.09; p <0.0001), and with higher 6-month eGFR (EST 6.03; p = 0.01). In appropriately selected patients with small renal masses, minimally-invasive PN is associated with acceptable perioperative outcomes. The use of a robotic approach over a standard laparoscopic approach can be advantageous with respect to clinically relevant outcomes, and it should be preferred when available.
Zeitschriftentitel:
Cent European J Urol
Jahr:
2020
Band / Volume:
73
Heft / Issue:
3
Seitenangaben Beitrag:
273-279
Volltext / DOI:
doi:10.5173/ceju.2020.0179
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/33133653
Print-ISSN:
2080-4806
TUM Einrichtung:
Urologische Klinik und Poliklinik
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