1637 CHRONIC KIDNEY DISEASE AFTER PARITAL NEPHRECTOMY FOR RENAL CELL CARCINOMA: IS THERE AN OVERALL SURVIVAL BENEFIT IN ADVANCED AGE?

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You have accessJournal of UrologyKidney Cancer: Localized (IV)1 Apr 20131637 CHRONIC KIDNEY DISEASE AFTER PARITAL NEPHRECTOMY FOR RENAL CELL CARCINOMA: IS THERE AN OVERALL SURVIVAL BENEFIT IN ADVANCED AGE? Yoon Soo Kyung, Sang Hoon Song, Ju Hyun Lim, Kyung Hyun Moon, Dalsan You, In Gab Jeong, Jun Hyuk Hong, Hanjong Ahn, and Choung-Soo Kim Yoon Soo KyungYoon Soo Kyung Seoul, Korea, Republic of More articles by this author , Sang Hoon SongSang Hoon Song Seoul, Korea, Republic of More articles by this author , Ju Hyun LimJu Hyun Lim Seoul, Korea, Republic of More articles by this author , Kyung Hyun MoonKyung Hyun Moon Ulsan, Korea, Republic of More articles by this author , Dalsan YouDalsan You Seoul, Korea, Republic of More articles by this author , In Gab JeongIn Gab Jeong Seoul, Korea, Republic of More articles by this author , Jun Hyuk HongJun Hyuk Hong Seoul, Korea, Republic of More articles by this author , Hanjong AhnHanjong Ahn Seoul, Korea, Republic of More articles by this author , and Choung-Soo KimChoung-Soo Kim Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3103AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There has been increasing evidence that partial nephrectomy (PN) is associated with improved overall survival compared to radical nephrectomy (RN) in patients with renal cell carcinoma (RCC). However, RN has been linked with low operative morbidity and more frequent use of minimally invasive technique. Therefore, it is hard to determine which is more beneficial for elderly patients with limited life expectancy (nephron sparing vs surgical morbidity). We compared overall survival and renal function in patients treated with RN or PN at advanced age. METHODS We retrospectively reviewed 186 patients older than 70 years who underwent RN (n=139) or PN (n=47) for RCC between January 2000 and December 2011. Clinicopathologic data were thoroughly analyzed and compared between RN and PN group. The MDRD equation was used to estimate the GFR (eGFR). The overall survival was assessed using Kaplan-Meier survival estimation. Cox proportional hazards regression model was used for multivariate analysis for prediction of overall survival. RESULTS 76 (54.7%) of the 139 patients in RN group and 18 (38.3%) of the 47 patients in PN group were treated with minimally invasive technique, respectively. During the median follow-up period of 55.1 months, 30 (21.6%) patients in RN group and 3 (6.4%) patients in PN group died, respectively. Patients in RN group were older (75.9 years vs. 73.3 years, p<0.001) and their tumors were larger (5.5cm vs. 2.7cm, p<0.001) compared to those in PN group. Distribution of Preoperative eGFR and the distribution of Fuhrman's nuclear grade and ASA score were not different between the two groups (p=0.405, p=0.128, and p=0.073, respectively). eGFR at postoperative 1 year was significantly lower in RN group than PN group (58.1ml/min vs. 60.6ml/min, p<0.001). Chronic kidney disease (CKD, <60 ml/min/1.73m2) was developed more frequently in RN group (88.5% vs. 66.0%, p<0.001). The 5-year overall survival rate was not different between RN and PN groups (75% vs. 86%, p=0.173). In multivariable analysis, only tumor size remained as an independent predictor for 5-year overall survival (HR 1.22, p=0.003). The type of surgery was not a significant predictor of overall survival. CONCLUSIONS Although CKD rate was lower after PN than RN, overall survival was similar in elderly patients. Careful inspection of underlying morbidity and individualized consultation regarding the risk and benefit of each surgical modality should be made before selection of operative method for renal tumor extirpation in patients with advanced age. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e673 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yoon Soo Kyung Seoul, Korea, Republic of More articles by this author Sang Hoon Song Seoul, Korea, Republic of More articles by this author Ju Hyun Lim Seoul, Korea, Republic of More articles by this author Kyung Hyun Moon Ulsan, Korea, Republic of More articles by this author Dalsan You Seoul, Korea, Republic of More articles by this author In Gab Jeong Seoul, Korea, Republic of More articles by this author Jun Hyuk Hong Seoul, Korea, Republic of More articles by this author Hanjong Ahn Seoul, Korea, Republic of More articles by this author Choung-Soo Kim Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...