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ORIGINAL ARTICLE   Free accessfree

Minerva Urologica e Nefrologica 2019 February;71(1):31-7

DOI: 10.23736/S0393-2249.18.03006-0


lingua: Inglese

Long-term oncologic and functional outcomes after robot-assisted partial nephrectomy in elderly patients

Mihai D. VARTOLOMEI 1, 2, Deliu V. MATEI 1, 3, Giuseppe RENNE 4, Valeria M. TRINGALI 1, Nicolae CRIȘAN 3, Gennaro MUSI 1, Francesco A. MISTRETTA 1, Andrea RUSSO 1, Andrea CONTI 1, Gabriele COZZI 1, Stefano LUZZAGO 1, Michele CATELLANI 1, Antonio CIOFFI 1, Giovanni CORDIMA 1, Roberto BIANCHI 1, Ettore DI TRAPANI 1, Alessandro SERINO 1, Maurizio DELOR 1, Raffaele BIANCO 1, Danilo BOTTERO 1, Matteo FERRO 1 , Ottavio DE COBELLI 1, 5

1 Department of Urology, European Institute of Oncology, Milan, Italy; 2 Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania; 3 Department of Urology, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania; 4 Department of Laboratory and Pathology, European Institute of Oncology, Milan, Italy; 5 University of Milan, Milan, Italy

BACKGROUND: The aim of this study was to assess the long-term oncologic and functional outcomes in elderly patients having undergone robot-assisted partial nephrectomy (RAPN) for renal cancer (RC).
METHODS: Sixty-one patients out of 323 who underwent RAPN for localized RC between July 2009 and March 2016 in our high-volume robotic surgery center (>800 procedures/year), had 70 years or more. Inclusion criteria of the study were age ≥70 years; pathological confirmed RCC and ASA Score ≤3. All patients were stratified according to PADUA classification system in three groups: <7 points, 8-9 points, >10 points. Trifecta was defined as a warm ischemia time (WIT) less then 25 min, negative surgical margins and no perioperative complications.
RESULTS: A total of 52 patients were included; median follow-up was 47 months. Median age was 74 yrs. (IQR 72-76.5). Complication rate was 15.4%. Trifecta failure was associated to PADUA Score (P=0.02), and tumor diameter (P=0.04). Renal function was altered in 10 (19.2%) patients before surgery and at last follow-up in 11 (21.1%) patients (CKD stage>2) The DFS, OS and CSS were 89.33%, 90.06% and 94.4%, respectively.
CONCLUSIONS: In a high-volume center, robot-assisted approach is feasible and safe in surgical fit elderly patients with good long-term oncologic outcomes.

KEY WORDS: Aged-Robotic surgical procedures - Carcinoma, renal cell - Elderly

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