Abstract
ABSTRACTPurpose:Radical treatment in elderly patients with renal tumor remains debatable due to uncertainties regarding the risk of surgical complications, risk of end-stage renal disease (ESRD) and survival benefit. The aim of the study was to assess outcomes of radical treatment for renal cancer in elderly patients.Materials and Methods:This retrospective analysis enrolled 507 consecutive patients treated with partial or radical nephrectomy due to renal mass. Patients with upfront metastatic disease (n=46) and patients lost to follow-up (n=110) were excluded from the analysis. Surgical, functional (screen for ESRD development) and survival outcomes were analyzed in patients aged >75 years in comparison to younger individuals.Results:The analyzed group included 55 elderly patients and 296 younger controls. Within the cohort a total of 148 and 203 patients underwent radical and partial nephrectomies respectively. The rate of surgical complications, including grade ≥3 Clavien- Dindo complications, did not differ between groups (3.6% vs. 4.4%, p=0.63). Median length of hospital stay was equal in both groups (7 days). During a follow-up (median 51.9 months, no difference between groups), ESRD occurred in 3.4% of controls and was not reported in elderly group (p=0.37). Younger patients demonstrated a statistically significant advantage in both overall survival and cancer-specific survival over elderly patients (OS 94.6% vs. 87% p=0.036, CSS 97.3% vs. 89.1% p=0.0008).Conclusions:Surgical treatment in elderly patients with renal tumor is as safe as in younger individuals and does not increase the risk of ESRD. However, cancer specific survival among these patients remains shorter than in younger patients.
Highlights
Incidence of renal cell carcinoma (RCC) has been constantly increasing in last decade [1]
Ibju | Surgical treatment for renal masses in the elderly radical management can constitute a challenge in elderly patients as impairment of kidney function, surgical complications and long postoperative recovery are believed to be more likely to occur in these patients
Control group n = 296 were overall survival, cancer-specific survival, surgical complications and renal functional outcomes defined by development of established diagnosis of end-stage renal disease (ESRD)
Summary
Incidence of renal cell carcinoma (RCC) has been constantly increasing in last decade [1]. The rising incidence of renal cell carcinoma is attributed to improved imaging facilitating incidental detection of smaller renal masses. According to the clinical guidelines of the European Association of Urology (EAU), surgery with curative intent remains standard treatment option for patients with renal cancer. Since progression of renal tumors is in general slow, it is unclear whether elderly patients live long enough to benefit from surgery in terms of overall- and cancer-specific survival. Foregoing controversies comprise rationale for active surveillance as alternative for partial and radical nephrectomy in elderly patients with small renal masses
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