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Minerva Urologica e Nefrologica 2020 February;72(1):99-108

DOI: 10.23736/S0393-2249.19.03583-5


lingua: Inglese

Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses

Alessandro VECCIA 1, 2, Paolo DELL’OGLIO 3, Alessandro ANTONELLI 4, Andrea MINERVINI 5, Giuseppe SIMONE 6, Benjamin CHALLACOMBE 7, Sisto PERDONÀ 8, James PORTER 9, Chao ZHANG 10, Umberto CAPITANIO 11, Chandru P. SUNDARAM 12, Giovanni CACCIAMANI 13, Monish ARON 13, Uzoma ANELE 1, Lance J. HAMPTON 1, Claudio SIMEONE 2, Geert DE NAEYER 3, Aaron BRADSHAWH 14, Andrea MARI 5, Riccardo CAMPI 5, Marco CARINI 5, Cristian FIORI 15, Michele GALLUCCI 6, Ken JACOBSOHN 16, Daniel EUN 17, Clayton LAU 18, Jihad KAOUK 19, Ithaar DERWEESH 14, Francesco PORPIGLIA 15, Alexandre MOTTRIE 3, Riccardo AUTORINO 1

1 Division of Urology, Virginia Commonwealth University Health System, Richmond, VA, USA; 2 Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science, and Public Health, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy; 3 ORSI Academy, Melle, and Department of Urology, OLV Ziekenhuis, Aalst, Belgium; 4 Department of Urology, University of Verona, Verona, Italy; 5 Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; 6 Department of Urology, “Regina Elena” National Cancer Institute, Rome, Italy; 7 MRC Centre for Transplantation, NIHR Biomedical Research Centre, Guy’s Hospital, King’s College, London, UK; 8 Unit of Urology, IRCCS Fondazione “G. Pascale”, Naples, Italy; 9 Swedish Urology Group, Swedish Medical Center, Seattle, WA, USA; 10 Department of Urology, Changhai Hospital, Shanghai Shi, China; 11 Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), San Raffaele Hospital IRCCS, Milan, Italy; 12 Department of Urology, Indiana University Health, Indianapolis, IN, USA; 13 USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 14 Department of Urology, UC San Diego Health System, La Jolla, CA, USA; 15 Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy; 16 Department of Urology, Medical College Wisconsin, Milwaukee, WI, USA; 17 Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; 18 Division of Urology, City of Hope National Medical Center, Duarte, CA, USA; 19 Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

BACKGROUND: Recent evidence suggests that the “oldest old” patients might benefit of partial nephrectomy (PN), but decision-making for this subset of patients is still controversial. Aim of this study is to compare outcomes of robotic partial (RPN) or radical nephrectomy (RRN) for large renal masses in patients older than 65 years.
METHODS: We identified 417≥65 years old patients who underwent RRN or RPN for cT1b or ≥cT2 renal mass at 17 high volume centers. Propensity score match analysis was performed adjusting for age, ASA≥3, pre-operative eGFR, and clinical tumor size. Predictors of complications, functional and oncological outcomes were evaluated in multivariable logistic and Cox regression models.
RESULTS: After propensity score analysis, 73 patients in the RPN group were matched with 74 in the RRN group. R.E.N.A.L. Score (9.6±1.7 vs. 8.6±1.7; P<0.001), and high complexity (56 vs. 15%; P=0.001) were higher in the RRN. Estimated blood loss was higher in the RPN group (200 vs. 100 mL; P<0.001). RPN showed higher rate of overall complications (38 vs. 23%; P=0.05), but not major complications (P=0.678). At last follow-up, RPN group showed better functional outcomes both in eGFR (55.4±22.6 vs. 45.7±15.7 mL/min; P=0.016) and lower eGFR variation (9.7 vs. 23.0 mL/min; P<0.001). The procedure type was not associated with recurrence free survival (RFS) (HR: 0.47; P=0.152) and overall mortality (OM) (0.22; P=0.084).
CONCLUSIONS: RPN in elderly patients with large renal masses provides acceptable surgical, and oncological outcomes allowing better functional preservation relative to RRN. The decision to undergo RPN in this subset of patients should be tailored on a case by case basis.

KEY WORDS: Nephrectomy; Aged; Patient outcome assessment

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