Efficacy and feasibility of robot-assisted partial nephrectomy for octogenarians: comparison with younger counterparts.

Abstract

To compare short-term functional and surgical outcomes of robot-assisted partial nephrectomy (RAPN) in patients ≥ 80years old and their younger counterparts, we retrospectively analyzed 1234 patients who underwent robot-assisted partial nephrectomy. The cohort was classified into three groups (young [< 65, N = 802], old [65-79, N = 376], and very old [≥ 80, N = 56]) based on the age at the time of surgery. The perioperative outcomes, including acute/mid-term renal function, perioperative safety profiles, and trifecta attainment, were compared among the three groups. Preoperative estimated glomerular filtration rate (eGFR) was significantly lower in the very old group (49.0mL/min/1.73 m2), compared to young (71.6) or old (60.9) (all, p < 0.001). The decline in %eGFR at acute kidney injury (young: - 6.1mL/min/1.73 m2, old: - 6.2, very old: - 5.3; all, p > 0.05) and occurrence of AKI (all, p > 0.05) was comparable among groups. Similarly, change in %eGFR at 6months was comparable across the three groups (young: - 5.0, old: - 6.3, very old: - 5.0; all, p > 0.05). Operative time and estimated blood loss were smaller in the very old group compared to the young or old groups. Furthermore, there were no differences in trifecta attainment rates among the groups. In the multivariable analyses using the reported possible confounders, age group was not shown to be a significant factor for predicting the renal function outcomes (acute or chronic) or trifecta attainment. Hence,RAPN for patients ≥ 80years old showed comparable renal function and safety profiles compared to younger counterparts.