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Aim: We compared survival and perioperative outcomes of robot-assisted laparoscopic partial nephrectomy (RAPN) and laparoscopic radical nephrectomy (LRN) for older patients (age 70 years or older) with stage 1 renal cell carcinoma (RCC).

Methods: This retrospective, single-center study included 260 patients who underwent RAPN and 44 patients who underwent LRN. The overall survival (OS) and perioperative outcomes were compared between these two groups using an inverse probability of treatment weighting (IPTW) analysis.

Results: Compared with the LRN group, a trend of more complications was observed in the RAPN group, including a higher body mass index (24 vs. 22 kg/m 2 ; P = 0.0002) and higher rates of hypertension (77% vs. 55%; P = 0.0029) and chronic kidney disease (62% vs. 36%; P = 0.0027). After adjustment by the IPTW analysis, the RAPN group had a shorter operative time (143 vs. 282 min; P = 0.033), shorter postoperative length of hospital stay (PLOS) (4.1 vs. 7.9 days; P = 0.004), and less change in the estimated glomerular filtration rate during surgery (-8.4% vs. -32%; P < 0.0001) than the LRN group; however, the perioperative complication rates were similar. Patients who underwent RAPN had better 5-year OS than those who underwent LRN (95% vs. 90%; log-rank, P = 0.017).

Conclusion: RAPN resulted in better OS and surgical outcomes, with shorter operative time, shorter PLOS, and better renal function preservation, than LRN for older patients with stage 1 RCC. Therefore, RAPN may be the primary option for patients indicated for surgical intervention. Geriatr Gerontol Int 2024; 24: 269-274.

Titel:	Comparisons of survival and surgical outcomes between minimally invasive partial nephrectomy and radical nephrectomy in elderly patients with stage 1 renal cell carcinoma.
Autor/in / Beteiligte Person:	Takagi, T ; Omae, K ; Yoshida, K ; Fukuda, H ; Kobari, Y ; Ishihara, H ; Iizuka, J ; Kondo, T ; Ishida, H
Link:	Full Text Finder (Volltext)
Zeitschrift:	Geriatrics & gerontology international, Jg. 24 (2024-03-01), Heft 3, S. 269-274
Veröffentlichung:	[Tokyo, Japan] : Carlton, Vic., Australia : Japan Geriatrics Society ; Blackwell Science, c2001-, 2024
Medientyp:	academicJournal
ISSN:	1447-0594 (electronic)
DOI:	10.1111/ggi.14808
Schlagwort:	Humans Aged Retrospective Studies Treatment Outcome Nephrectomy adverse effects Nephrectomy methods Propensity Score Carcinoma, Renal Cell surgery Carcinoma, Renal Cell pathology Kidney Neoplasms surgery Kidney Neoplasms pathology Laparoscopy adverse effects Laparoscopy methods
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Geriatr Gerontol Int] 2024 Mar; Vol. 24 (3), pp. 269-274. <i>Date of Electronic Publication: </i>2024 Jan 21. MeSH Terms: Carcinoma, Renal Cell* / surgery ; Carcinoma, Renal Cell* / pathology ; Kidney Neoplasms* / surgery ; Kidney Neoplasms* / pathology ; Laparoscopy* / adverse effects ; Laparoscopy* / methods ; Humans ; Aged ; Retrospective Studies ; Treatment Outcome ; Nephrectomy / adverse effects ; Nephrectomy / methods ; Propensity Score References: Campbell S, Uzzo RG, Allaf ME et al. Renal mass and localized renal cancer: AUA guideline. J Urol 2017; 198: 520-529. ; Ljungberg B, Bensalah K, Canfield S et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 2015; 67: 913-924. ; Mir MC, Pavan N, Capitanio U et al. Partial versus radical nephrectomy in very elderly patients: a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project). World J Urol 2020; 38: 151-158. ; Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-213. ; Matsuo S, Imai E, Horio M et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 2009; 53: 982-992. ; Ristau BT, Handorf EA, Cahn DB, Kutikov A, Uzzo RG, Smaldone MC. Partial nephrectomy is not associated with an overall survival advantage over radical nephrectomy in elderly patients with stage Ib-II renal masses: an analysis of the national cancer data base. Cancer 2018; 124: 3839-3848. ; Takagi T, Kondo T, Iizuka J et al. Comparison of survival rates in stage 1 renal cell carcinoma between partial nephrectomy and radical nephrectomy patients according to age distribution: a propensity score matching study. BJU Int 2015; 117: E52-E59. ; Lane BR, Demirjian S, Derweesh IH et al. Survival and functional stability in chronic kidney disease due to surgical removal of nephrons: importance of the new baseline glomerular filtration rate. Eur Urol 2015; 68: 996-1003. ; Antonelli A, Veccia A, Pavan N et al. Outcomes of partial and radical nephrectomy in octogenarians - a multicenter international study (Resurge). Urology 2019; 129: 139-145. ; Anceschi U, Brassetti A, Tuderti G et al. Risk factors for progression of chronic kidney disease after robotic partial nephrectomy in elderly patients: results from a multi-institutional collaborative series. Minerva Urol Nephrol 2022; 74: 452-460. ; Simone G, Misuraca L, Tuderti G et al. Purely off-clamp robotic partial nephrectomy: preliminary 3-year oncological and functional outcomes. Int J Urol 2018; 25: 606-614. ; Tuderti G, Mastroianni R, Anceschi U et al. Assessing the trade-off between the safety and effectiveness of off-clamp robotic partial nephrectomy for renal masses with a high RENAL score: a propensity score-matched comparison of perioperative and functional outcomes in a multicenter analysis. Eur Urol Focus 2023; 44: S28. ; Tuderti G, Brassetti A, Mastroianni R et al. Expanding the limits of nephron-sparing surgery: surgical technique and mid-term outcomes of purely off-clamp robotic partial nephrectomy for totally endophytic renal tumors. Int J Urol 2022; 29: 282-288. ; Bertolo R, Bove P, Sandri M et al. Randomized clinical trial comparing on-clamp versus off-clamp laparoscopic partial nephrectomy for small renal masses (CLOCK II laparoscopic study): a intention-to-treat analysis of perioperative outcomes. Eur Urol Open Sci 2022; 46: 75-81. ; Sharma G, Shah M, Ahluwalia P et al. Perioperative outcomes following robot-assisted partial nephrectomy in elderly patients. World J Urol 2022; 40: 2789-2798. ; Ishiyama Y, Kondo T, Yoshida K, Iizuka J, Tanabe K, Takagi T. Efficacy and feasibility of robot-assisted partial nephrectomy for octogenarians: comparison with younger counterparts. J Robotic Surg 2022; 16: 1165-1173. ; Bertolo R, Garisto J, Armanyous S, Agudelo J, Lioudis M, Kaouk J. Perioperative, oncological and functional outcomes after robotic partial nephrectomy vs. cryoablation in the elderly: a propensity score matched analysis. Urol Oncol-Seminars Original Investig 2019; 37: 294.e9-294.e15. ; Marchioni M, Cheaib JG, Takagi T et al. Active surveillance for small renal masses in elderly patients does not increase overall mortality rates compared to primary intervention: a propensity score weighted analysis. Minerva Urol Nephrol 2021; 73: 781-788. Contributed Indexing: Keywords: elderly; kidney neoplasm; nephrectomy; robotic; surgical outcome Entry Date(s): Date Created: 20240121 Date Completed: 20240305 Latest Revision: 20240305 Update Code: 20240305

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Comparisons of survival and surgical outcomes between minimally invasive partial nephrectomy and radical nephrectomy in elderly patients with stage 1 renal cell carcinoma.