Renal cell carcinoma in the elderly: Is partial nephrectomy the right surgical option?

Abstract

e15040 Background: Data are scarce on literature describing surgical outcomes in elderly patients undergoing treatment for renal cell carcinoma (RCC). The goals of this study were to determine overall- and cancer-specific survival, use of radical versus partial nephrectomy, and complication rates in elderly patients with RCC. Methods: 532 patients who underwent extirpative surgery for clinically diagnosed RCC between 1994 and 2009 were identified using a single-institution IRB-approved database. Of these patients, 127 (24%) were 75 years of age or older. These patients were further separated into groups based on surgical type and incidence of complications and were stratified by gender, tumor stage, and tumor grade. Preoperative and postoperative creatinine clearances and length of stay were compared among the groups. Cox proportional hazard modeling and Kaplan-Meier analyses were used to determine overall- and cancer-specific survival among the cohorts. Results: Older patients were more likely to undergo laparoscopic radical than partial nephrectomy than their younger counterparts (p=0.003), and had longer average hospital stays (4.0 versus 2.7 days, p<0.001). Older patients were 3.4 times more likely to experience an immediate (within 24 hours) complication (95% CI 1.37-8.30, p=0.008), and there was a trend toward a higher overall complication rate in elderly patients. Complication rates, however, were similar after radical or partial nephrectomy. Calculated creatinine clearance in the radical nephrectomy group (18.9 mL/min/m2) decreased more than in the partial nephrectomy group (8.0 mL/min/m2, p<0.0001). Despite this, there was no significant difference in overall or cancer-specific survival between younger and older patients. Median length of followup were 13.3 (0-135) and 19.2 (0-164) months for younger and older patients, respectively. Conclusions: Extirpative surgery is safe in elderly patients with RCC. The risk of immediate complications is increased in older than younger patients, but risk appears unrelated to type of surgery. Partial nephrectomy should be advocated when feasible in order to maintain renal function. No significant financial relationships to disclose.