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Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group
DC Field | Value | Language |
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dc.contributor.author | 나군호 | - |
dc.date.accessioned | 2020-12-01T17:46:48Z | - |
dc.date.available | 2020-12-01T17:46:48Z | - |
dc.date.issued | 2020-09 | - |
dc.identifier.uri | https://ir.ymlib.yonsei.ac.kr/handle/22282913/180446 | - |
dc.description.abstract | 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. | - |
dc.description.statementOfResponsibility | restriction | - |
dc.language | English | - |
dc.publisher | Elsevier B.V. | - |
dc.relation.isPartOf | EUROPEAN UROLOGY FOCUS | - |
dc.rights | CC BY-NC-ND 2.0 KR | - |
dc.title | Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group | - |
dc.type | Article | - |
dc.contributor.college | College of Medicine (의과대학) | - |
dc.contributor.department | Dept. of Urology (비뇨의학교실) | - |
dc.contributor.googleauthor | Ahmet Bindayi | - |
dc.contributor.googleauthor | Riccardo Autorino | - |
dc.contributor.googleauthor | Umberto Capitanio | - |
dc.contributor.googleauthor | Nicola Pavan | - |
dc.contributor.googleauthor | Maria Carmen Mir | - |
dc.contributor.googleauthor | Alessandro Antonelli | - |
dc.contributor.googleauthor | Toshio Takagi | - |
dc.contributor.googleauthor | Riccardo Bertolo | - |
dc.contributor.googleauthor | Tobias Maurer | - |
dc.contributor.googleauthor | Koon Ho Rha | - |
dc.contributor.googleauthor | Jean Alexandre Long | - |
dc.contributor.googleauthor | Bo Yang | - |
dc.contributor.googleauthor | Luigi Schips | - |
dc.contributor.googleauthor | Estevão Lima | - |
dc.contributor.googleauthor | Alberto Breda | - |
dc.contributor.googleauthor | Estefania Linares | - |
dc.contributor.googleauthor | Antonio Celia | - |
dc.contributor.googleauthor | Cosimo De Nunzio | - |
dc.contributor.googleauthor | Ryan Dobbs | - |
dc.contributor.googleauthor | Sunil Patel | - |
dc.contributor.googleauthor | Zachary Hamilton | - |
dc.contributor.googleauthor | Andrew Tracey | - |
dc.contributor.googleauthor | Alessandro Larcher | - |
dc.contributor.googleauthor | Carlo Trombetta | - |
dc.contributor.googleauthor | Carlotta Palumbo | - |
dc.contributor.googleauthor | Kazunari Tanabe | - |
dc.contributor.googleauthor | Thomas Amiel | - |
dc.contributor.googleauthor | Ali Raheem | - |
dc.contributor.googleauthor | Gaelle Fiard | - |
dc.contributor.googleauthor | Chao Zhang | - |
dc.contributor.googleauthor | Roberto Castellucci | - |
dc.contributor.googleauthor | Joan Palou | - |
dc.contributor.googleauthor | Stephen Ryan | - |
dc.contributor.googleauthor | Simone Crivellaro | - |
dc.contributor.googleauthor | Francesco Montorsi | - |
dc.contributor.googleauthor | Francesco Porpiglia | - |
dc.contributor.googleauthor | Ithaar H Derweesh | - |
dc.identifier.doi | 10.1016/j.euf.2019.02.010 | - |
dc.contributor.localId | A01227 | - |
dc.relation.journalcode | J03924 | - |
dc.identifier.eissn | 2405-4569 | - |
dc.identifier.pmid | 30799289 | - |
dc.identifier.url | https://www.sciencedirect.com/science/article/pii/S2405456919300306 | - |
dc.subject.keyword | Carcinoma | - |
dc.subject.keyword | Chronic Kidney Disease | - |
dc.subject.keyword | Elderly | - |
dc.subject.keyword | Outcome Assessment | - |
dc.subject.keyword | Partial Nephrectomy | - |
dc.subject.keyword | Renal Cell | - |
dc.subject.keyword | Trifecta | - |
dc.contributor.alternativeName | Rha, Koon Ho | - |
dc.contributor.affiliatedAuthor | 나군호 | - |
dc.citation.volume | 6 | - |
dc.citation.number | 5 | - |
dc.citation.startPage | 982 | - |
dc.citation.endPage | 990 | - |
dc.identifier.bibliographicCitation | EUROPEAN UROLOGY FOCUS, Vol.6(5) : 982-990, 2020-09 | - |
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