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Dokumenttyp:
Article; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
Autor(en):
Bindayi, Ahmet; Autorino, Riccardo; Capitanio, Umberto; Pavan, Nicola; Mir, Maria Carmen; Antonelli, Alessandro; Takagi, Toshio; Bertolo, Riccardo; Maurer, Tobias; Ho Rha, Koon; Long, Jean Alexandre; Yang, Bo; Schips, Luigi; Lima, Estevão; Breda, Alberto; Linares, Estefania; Celia, Antonio; De Nunzio, Cosimo; Dobbs, Ryan; Patel, Sunil; Hamilton, Zachary; Tracey, Andrew; Larcher, Alessandro; Trombetta, Carlo; Palumbo, Carlotta; Tanabe, Kazunari; Amiel, Thomas; Raheem, Ali; Fiard, Gaelle; Zhang, C...     »
Titel:
Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group.
Abstract:
BACKGROUND: Partial nephrectomy (PN) in elderly patients is underutilized with concerns regarding risk of complications and potential for poor outcomes. OBJECTIVE: To evaluate quality and functional outcomes of PN in patients >75 yr using trifecta as a composite outcome of surgical quality. DESIGN, SETTING, AND PARTICIPANTS: Multicenter retrospective analysis of 653 patients aged >75 yr who underwent PN (REnal SURGery in Elderly [RESURGE] Group). INTERVENTION: PN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcome was achievement of trifecta (negative margin, no major [Clavien ≥3] urological complications, and ≥90% estimated glomerular filtration rate [eGFR] recovery). Secondary outcomes included chronic kidney disease (CKD) stage III and CKD upstaging. Multivariable analysis (MVA) was used to assess variables for achieving trifecta and functional outcomes. Kaplan-Meier survival analysis (KMA) was used to calculate renal functional outcomes. RESULTS AND LIMITATIONS: We analyzed 653 patients (mean age 78.4 yr, median follow-up 33 mo; 382 open, 157 laparoscopic, and 114 robotic). Trifecta rate was 40.4% (n=264). Trifecta patients had less transfusion (p<0.001), lower intraoperative (5.3% vs 27%, p<0.001) and postoperative (25.4% vs 37.8%, p=0.001) complications, shorter hospital stay (p=0.045), and lower ΔeGFR (p <0.001). MVA for predictive factors for trifecta revealed decreasing RENAL nephrometry score (odds ratio [OR] 1.26, 95% confidence interval 1.07-1.51, p=0.007) as being associated with increased likelihood to achieve trifecta. Achievement of trifecta was associated with decreased risk of CKD upstaging (OR 0.47, 95% confidence interval 0.32-0.62, p<0.001). KMA showed that trifecta patients had improved 5-yr freedom from CKD stage 3 (93.5% vs 57.7%, p<0.001) and CKD upstaging (84.3% vs 8.2%, p<0.001). Limitations include retrospective design. CONCLUSIONS: PN in elderly patients can be performed with acceptable quality outcomes. Trifecta was associated with decreased tumor complexity and improved functional preservation. PATIENT SUMMARY: We looked at quality outcomes after partial nephrectomy in elderly patients. Acceptable quality outcomes were achieved, measured by a composite outcome called trifecta, whose achievement was associated with improved kidney functional preservation.
Zeitschriftentitel:
Eur Urol Focus
Jahr:
2020
Band / Volume:
6
Heft / Issue:
5
Seitenangaben Beitrag:
982-990
Volltext / DOI:
doi:10.1016/j.euf.2019.02.010
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/30799289
TUM Einrichtung:
Urologische Klinik und Poliklinik
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