Renal surgery for the older population: time for a paradigm shift? Data from the RESURGE project.

Abstract

To provide a comprehensive analysis of the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for renal cell carcinoma (RCC) in older patients. The RESURGE project is a multi-institutional dataset including 24 institutions worldwide collecting data of patients older than 75years old who underwent RN or PN. Among three already published studies, RN patients were older (p < 0.001), and presented a higher RENAL score (p < 0.001). PN showed shorter operative time (p = 0.020), as well as lower eGFR postoperative decline (p < 0.001). No statistically significant difference was found in terms of major complications between PN and RN. PN was shown to be protective factor with respect to de novo chronic kidney disease (CKD) (p < 0.001). RN was related to a higher rate of recurrence (p < 0.001), whereas PN demonstrated lower risk of cancer-specific mortality (CSM) (p = 0.05). Data from the RESURGE project suggest that kidney cancer surgery could be feasible and safe in well-selected older patients. When surgery is indicated, PN should be preferred to RN as it offers better functional preservation. Otherwise, less invasive or non-interventional management options should be considered.