Study: Older Age Should Not Preclude Partial Nephrectomy

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Partial and radical nephrectomy were associated with similar cancer-specific and overall survival in elderly patients.
Partial and radical nephrectomy were associated with similar cancer-specific and overall survival in elderly patients.

Partial nephrectomy (PN) and radical nephrectomy (RN) are associated with similar survival outcomes among elderly patients, a new study suggests.

The study, by researchers at the Johns Hopkins School of Medicine in Baltimore led by Mark W. Ball, MD, included 787 patients aged 65 years and older with solitary cT2-T2 renal masses. Of these, 437 (55.5%) underwent PN and 350 (44.5%) underwent RN. The median follow-up was 36 months. In unadjusted analyses, PN was associated with better cancer-specific survival (CSS) than RN at 5 years (100% vs. 87.5%) and 10 years (100% vs. 80.2%), the researchers reported in Urology (2016; published online ahead of print). PN also was associated with better overall survival (OS) at 5 years (80.2% vs. 65.4%) and 10 years (60.6% vs. 35.1%). In multivariate analysis controlling for patient age, tumor diameter, ASA score, and pathologic stage, PN and RN patients had similar CSS and OS. Perioperative outcomes and complication rates were similar between the treatment groups.

Patients in the PN cohort were significantly younger (median 70.3 vs. 71.9 years) and had significantly lower ASA scores (2.6 vs. 2.8), smaller tumors (diameter 2.8 vs. 5.0 cm), and lower proportion of patients with renal cell carcinoma (76.7% vs. 87.4%).

The authors concluded that “age alone should not be a contraindication to nephron-sparing surgery.”

The PN and RN cohorts had a similar estimated glomerular filtration rate (eGFR) at baseline (67.7 vs 64.7 mL/min/1.73 m2). PN was associated with more favorable postoperative renal function. At last follow-up, the eGFR was 59.1 mL/min/1.73 m2 in the PN group compared with 42.5 mL/min/1.73 m2 in the RN group.

Dr Ball's group found that individual complication varied by surgical approach. The PN group had significantly higher rates of bleeding ((7.3% vs. 1.5%) and urine leak (10.3% vs 0.7%) than the RN group. The RN group had significantly higher rates of urinary retention (28% vs 9.7%), wound infection (13.2% vs 4.2%), and wound dehiscence (3.7% vs 0%).

Reference

1. An JY, Ball MW, Gorin MA, et al. Partial versus radical nephrectomy for T1-T2 renal masses in the elderly: Comparison of complications, renal function, and oncologic outcomes. Urology 2016; published online ahead of print.

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