Partial Versus Radical Nephrectomy in Elderly Patients With Renal Cancer
Posted: Monday, August 5, 2019
According to research published in Urology, partial nephrectomy is recommended over radical nephrectomy when possible in patients aged 80 years or older with renal cancer. Known as RESURGE, the study sought to determine the outcomes and risk of complications associated with each type of surgery in octogenarians.
“In this patient population both [radical nephrectomy] and [partial nephrectomy] carry a non-negligible risk of complications,” concluded Alessandro Antonelli, MD, of the University of Brescia in Italy, and colleagues. “When surgical removal is indicated, [partial nephrectomy] should be preferred, whenever technically feasible, as it can offer better preservation of renal function, without increasing the risk of complications. Moreover, a minimally invasive approach should be pursued, as it can translate into lower surgical morbidity.”
A total of 585 patients with a median age of 83 years who had previously undergone radical nephrectomy (n = 364) or partial nephrectomy (n = 221) were included in the study. At a median follow-up of 39 months, 105 deaths due to renal cancer had occurred, with 161 deaths recorded overall. Patients who underwent partial nephrectomy were found to have a lower rate of significant estimated glomerular filtration rate decrease (less than 25%) at 1 month (18% vs. 59%) and at 6 months (23% vs. 65%).
Only one meaningful difference was identified in the risk rates for complications after surgery. Patients who underwent laparoscopic radical nephrectomy had a lower risk rate than those who underwent open radical nephrectomy (odds ratio = 0.42; P = .04). Patients who had experienced radical nephrectomy tended to have larger tumors (P < .0001), an advanced clinical stage (P < .001), and an older age (P = .0084).
Disclosure: The study authors reported no conflicts of interest.