MP21-20 THE IMPACT OF ISCHEMIA ON CHRONIC KIDNEY DISEASE PROGRESSION AFTER ROBOTIC PARTIAL NEPHRECTOMY IN PATIENTS OVER 75 YEARS OLD: RESULTS OF A MULTI-INSTITUTIONAL COLLABORATIVE SERIES (ROSULA)

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP21)1 Apr 2020MP21-20 THE IMPACT OF ISCHEMIA ON CHRONIC KIDNEY DISEASE PROGRESSION AFTER ROBOTIC PARTIAL NEPHRECTOMY IN PATIENTS OVER 75 YEARS OLD: RESULTS OF A MULTI-INSTITUTIONAL COLLABORATIVE SERIES (ROSULA) Umberto Anceschi*, Aldo Brassetti, Gabriele Tuderti, Andrea Minervini, Andrea Mari, Antonio Andrea Grasso, Marco Carini, Umberto Capitanio, Alessandro Larcher, Francesco Montorsi, Riccardo Autorino, Alessandro Veccia Richmond, VA, Daniele Amparore, Francesco Porpiglia, Ithar Deerwesh, Daniel Eun, Jennifer Lee, Philadelphia, PA Michele Gallucci, and Giuseppe Simone Umberto Anceschi*Umberto Anceschi* More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Andrea MariAndrea Mari More articles by this author , Antonio Andrea GrassoAntonio Andrea Grasso More articles by this author , Marco CariniMarco Carini More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Alessandro Veccia Richmond, VAAlessandro Veccia Richmond, VA More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Ithar DeerweshIthar Deerwesh More articles by this author , Daniel EunDaniel Eun More articles by this author , Jennifer Lee, PhiladelphiaJennifer Lee, Philadelphia More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000854.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) in elderly patients (over 75 years) is certainly underused with concerns regarding risk of major complications and a negligible impact on renal function. The aim of this study was to compare the progression to chronic kidney disease (CKD) of purely off-clamp vs on-clamp robotic partial nephrectomy in patients ≥ 75 years in a multinstitutional series. METHODS: A collaborative multicentric renal surgery dataset (ROSULA) was queried for “partial nephrectomy” and “age≥75 years”. Between May 2008 and October 2019, a total of 207 patients who underwent robotic partial nephrectomy (RAPN) matched the inclusion criteria. Newly onset of any CKD stage (3a,3b,4,5) after surgery was computed by Kaplan-Meier curve and compared for surgical approach (purely-off clamp vs on-clamp) with the log-rank test. Univariable and multivariable Cox regression analyses were performed to identify predictors of CKD progression. For all statistical analyses, a two-sided p < 0.05 was considered significant. RESULTS: Mean age of the cohort considered was 77 years (IQR 76-81). At a median follow-up of 25 months (IQR 12-42.2) newly onset of CKD-3a and CKD-3b stages were observed in 7.2% and 8.7% of patients, respectively. At Kaplan-Meier analysis, on-clamp approach was associated with a significantly higher risk of developing a CKD progression, while a purely-off clamp approach was associated with a significantly lower risk of renal decline in patients ≥ 80 years old. (Figure 1; p=0.04 - Figure 2; p=0.03). On univariable analysis surgical approach (HR 4.22 – 95% CI 1.52-11.6; p=0.006) warm ischemia time (HR 1.05 – 95% CI 1.02-1.08; p=0.01) and tumor size (HR 1.05 -95% CI 1.01-1.09) were all significant predictors of renal function decline. On multivariable analysis warm ischemia time (HR 1.04 – 95% CI 1.01-1.08; p=0.006) was the only independent predictor of any CKD stage progression. CONCLUSIONS: Robotic partial nephrectomy in the elderly population may achieve acceptable mid-term functional outcomes. Ischemia time during robotic partial nephrectomy remains the only modifiable surgical factor to avoid a significant progression of CKD even at the oldest age. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e325-e326 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Umberto Anceschi* More articles by this author Aldo Brassetti More articles by this author Gabriele Tuderti More articles by this author Andrea Minervini More articles by this author Andrea Mari More articles by this author Antonio Andrea Grasso More articles by this author Marco Carini More articles by this author Umberto Capitanio More articles by this author Alessandro Larcher More articles by this author Francesco Montorsi More articles by this author Riccardo Autorino More articles by this author Alessandro Veccia Richmond, VA More articles by this author Daniele Amparore More articles by this author Francesco Porpiglia More articles by this author Ithar Deerwesh More articles by this author Daniel Eun More articles by this author Jennifer Lee, Philadelphia More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...