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Minerva Urology and Nephrology 2022 April;74(2):146-60

DOI: 10.23736/S2724-6051.21.04583-3


language: English

Impact of frailty on perioperative and oncologic outcomes in patients undergoing surgery or ablation for renal cancer: a systematic review

Riccardo CAMPI 1, 2 , Alessandro BERNI 1, Daniele AMPARORE 3, Riccardo BERTOLO 4, Umberto CAPITANIO 5, 6, Umberto CARBONARA 7, Selcuk ERDEM 8, Alexandre INGELS 9, 10, Onder KARA 11, Tobias KLATTE 12, 13, Maximilian KRIEGMAIR 14, Michele MARCHIONI 15, 16, Andrea MINERVINI 17, Maria C. MIR 18, Rocco PAPALIA 19, Nicola PAVAN 20, Angela PECORARO 3, Juan GOMEZ RIVAS 21, 22, Giulia RIVASI 23, Eduard ROUSSEL 24, Andrea UNGAR 23, Sergio SERNI 1, 2, Francesco ESPERTO 19, 22, European Society of Residents in Urology (ESRU), EAU Young Academic Urologists (YAU) Renal Cancer Group 

1 Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; 2 Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; 3 Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy; 4 Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy; 5 Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy; 6 Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; 7 Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy; 8 Division of Urologic Oncology, Department of Urology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey; 9 Department of Urology, University Hospital Henri Mondor, APHP, Créteil, France; 10 Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France; 11 Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey; 12 Department of Surgery, University of Cambridge, Cambridge, UK; 13 Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK; 14 Department of Urology, University Medical Center Mannheim, Mannheim, Germany; 15 Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. D’Annunzio University of Chieti-Pescara, Chieti, Italy; 16 Department of Urology, SS. Annunziata Hospital, G. D’Annunzio University of Chieti, Chieti, Italy; 17 Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, University of Florence, Careggi Hospital, Florence, Italy; 18 Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain; 19 Department of Urology, Campus Bio-Medico University, Rome, Italy; 20 Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy; 21 Department of Urology, La Paz University Hospital, Madrid, Spain; 22 European Society of Residents in Urology (ESRU), Arnhem, the Netherlands; 23 Division of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, Florence, Italy; 24 Department of Urology, University Hospitals Leuven, Leuven, Belgium

INTRODUCTION: Frailty has been recognized as a major risk factor for adverse perioperative and oncological outcomes in patients with genitourinary malignancies. Yet, the evidence supporting such an association in patients with renal cell carcinoma (RCC) is still sparse. Herein we provide an updated comprehensive overview of the impact of frailty on perioperative and oncologic outcomes in patients undergoing surgery or ablation for RCC.
EVIDENCE ACQUISITION: A systematic review of the English-language literature was conducted using the MEDLINE (via PubMed), Web of Science and the Cochrane Library databases according to the principles highlighted by the EAU Guidelines Office and the PRISMA statement recommendations. The review protocol was registered on PROSPERO (CRD42021242516). The overall quality of evidence was assessed according to GRADE recommendations.
EVIDENCE SYNTHESIS: Overall, 18 studies were included in the qualitative analysis. Most of these were retrospective single-center series including patients undergoing surgery for non-metastatic RCC. The overall quality of evidence was low. A variety of measures were used for frailty assessment, including the Canadian Study of Health and Aging Frailty Index, the five-item frailty index, the Modified Rockwood’s Clinical Frailty Scale Score, the Hopkins Frailty score, the Groningen Frailty Index, and the Geriatric nutritional risk index. Sarcopenia was defined based on the Lumbar skeletal muscle mass at cross-sectional imaging, the skeletal muscle index, the total psoas area, or the Psoas Muscle Index. Overall, available studies point to frailty and sarcopenia as potential independent risk factors for worse perioperative and oncological outcomes after surgery or ablation for different RCC stages. Increased patient’s frailty was indeed associated with higher risk of perioperative complications, healthcare resources utilization, readmission rates and longer hospitalization periods, as well as potentially lower cancer specific or overall survival.
CONCLUSIONS: Frailty has been consistently associated with worse outcomes after surgery for RCC, reinforcing the value of preoperative frailty assessment in carefully selected patients. Given the low quality of the available evidence (especially in the setting of tumor ablation), prospective studies are needed to standardize frailty assessments and to identify patients who are expected to benefit most from preoperative geriatric evaluation, aiming to optimize decision-making and postoperative outcomes in patients with RCC.

KEY WORDS: Complications; Frailty; Nephrectomy; Outcomes; Renal Cancer

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