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Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group

 Ahmet Bindayi  ;  Riccardo Autorino  ;  Umberto Capitanio  ;  Nicola Pavan  ;  Maria Carmen Mir  ;  Alessandro Antonelli  ;  Toshio Takagi  ;  Riccardo Bertolo  ;  Tobias Maurer  ;  Koon Ho Rha  ;  Jean Alexandre Long  ;  Bo Yang  ;  Luigi Schips  ;  Estevão Lima  ;  Alberto Breda  ;  Estefania Linares  ;  Antonio Celia  ;  Cosimo De Nunzio  ;  Ryan Dobbs  ;  Sunil Patel  ;  Zachary Hamilton  ;  Andrew Tracey  ;  Alessandro Larcher  ;  Carlo Trombetta  ;  Carlotta Palumbo  ;  Kazunari Tanabe  ;  Thomas Amiel  ;  Ali Raheem  ;  Gaelle Fiard  ;  Chao Zhang  ;  Roberto Castellucci  ;  Joan Palou  ;  Stephen Ryan  ;  Simone Crivellaro  ;  Francesco Montorsi  ;  Francesco Porpiglia  ;  Ithaar H Derweesh 
 EUROPEAN UROLOGY FOCUS, Vol.6(5) : 982-990, 2020-09 
Journal Title
Issue Date
Carcinoma ; Chronic Kidney Disease ; Elderly ; Outcome Assessment ; Partial Nephrectomy ; Renal Cell ; Trifecta
Background: Partial nephrectomy (PN) in elderly patients is underutilized with concerns regarding risk of complications and potential for poor outcomes. Objective: To evaluate quality and functional outcomes of PN in patients >75 yr using trifecta as a composite outcome of surgical quality. Design, setting, and participants: Multicenter retrospective analysis of 653 patients aged >75 yr who underwent PN (REnal SURGery in Elderly [RESURGE] Group). Intervention: PN. Outcome measurements and statistical analysis: Primary outcome was achievement of trifecta (negative margin, no major [Clavien ≥3] urological complications, and ≥90% estimated glomerular filtration rate [eGFR] recovery). Secondary outcomes included chronic kidney disease (CKD) stage III and CKD upstaging. Multivariable analysis (MVA) was used to assess variables for achieving trifecta and functional outcomes. Kaplan-Meier survival analysis (KMA) was used to calculate renal functional outcomes. Results and limitations: We analyzed 653 patients (mean age 78.4 yr, median follow-up 33 mo; 382 open, 157 laparoscopic, and 114 robotic). Trifecta rate was 40.4% (n=264). Trifecta patients had less transfusion (p<0.001), lower intraoperative (5.3% vs 27%, p<0.001) and postoperative (25.4% vs 37.8%, p=0.001) complications, shorter hospital stay (p=0.045), and lower ΔeGFR (p <0.001). MVA for predictive factors for trifecta revealed decreasing RENAL nephrometry score (odds ratio [OR] 1.26, 95% confidence interval 1.07-1.51, p=0.007) as being associated with increased likelihood to achieve trifecta. Achievement of trifecta was associated with decreased risk of CKD upstaging (OR 0.47, 95% confidence interval 0.32-0.62, p<0.001). KMA showed that trifecta patients had improved 5-yr freedom from CKD stage 3 (93.5% vs 57.7%, p<0.001) and CKD upstaging (84.3% vs 8.2%, p<0.001). Limitations include retrospective design. Conclusions: PN in elderly patients can be performed with acceptable quality outcomes. Trifecta was associated with decreased tumor complexity and improved functional preservation. Patient summary: We looked at quality outcomes after partial nephrectomy in elderly patients. Acceptable quality outcomes were achieved, measured by a composite outcome called trifecta, whose achievement was associated with improved kidney functional preservation.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
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