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Outcomes of minimally invasive partial nephrectomy among very elderly patients: report from the RESURGE collaborative international database

 Alessandro Larcher  ;  Christopher J D Wallis  ;  Nicola Pavan  ;  Francesco Porpiglia  ;  Toshio Takagi  ;  Kazunari Tanabe  ;  Koon H Rha  ;  Ali Abdel Raheem  ;  Bo Yang  ;  Chao Zang  ;  Sisto Perdonà  ;  Giuseppe Quarto  ;  Tobias Maurer  ;  Thomas Amiel  ;  Luigi Schips  ;  Roberto Castellucci  ;  Simone Crivellaro  ;  Ryan Dobbs  ;  Gianfranco Baiamonte  ;  Antonio Celia  ;  Bernardino De Concilio  ;  Maria Furlan  ;  Estevão Lima  ;  Estefania Linares  ;  Salvatore Micali  ;  Daniele Amparore  ;  Geert De Naeyer  ;  Carlo Trombetta  ;  Lance J Hampton  ;  Andrew Tracey  ;  Ahmet Bindayi  ;  Alessandro Antonelli  ;  Ithaar Derweesh  ;  Carme Mir  ;  Francesco Montorsi  ;  Alexandre Mottrie  ;  Riccardo Autorino  ;  Umberto Capitanio 
 CENTRAL EUROPEAN JOURNAL OF UROLOGY, Vol.73(3) : 273-279, 2020-09 
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elderly ; kidney cancer ; laparoscopic partial nephrectomy ; minimally invasive surgery ; robot-assisted partial nephrectomy
The aim of the study was to perform a comprehensive investigation of clinical outcomes of robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in elderly patients presenting with a renal mass. The REnal SURGery in Elderly (RESURGE) collaborative database was queried to identify patients aged 75 or older diagnosed with cT1-2 renal mass and treated with RAPN or LPN. Study outcomes were: overall complications (OC); warm ischemia time (WIT) and 6-month estimated glomerular filtration rate (eGFR); positive surgical margins (PSM), disease recurrence (REC), cancer-specific mortality (CSM) and other-cause mortality (OCM). Descriptive statistics, Kaplan-Meier, smoothed Poisson plots and logistic and linear regression models (MVA) were used. Overall, 216 patients were included in this analysis. OC rate was 34%, most of them being of low Clavien grade. Median WIT was 17 minutes and median 6-month eGFR was 54 ml/min/1.73 m2. PSM rate was 5%. After a median follow-up of 20 months, the 5-year rates of REC, CSM and OCM were 4, 4 and 5%, respectively. At MVA predicting perioperative morbidity, RAPN relative to LPN (odds ratio [OR] 0.33; p <0.0001) was associated with lower OC rate. At MVA predicting functional outcomes, RAPN relative to LPN was associated with shorter WIT (estimate [EST] -4.09; p <0.0001), and with higher 6-month eGFR (EST 6.03; p = 0.01). In appropriately selected patients with small renal masses, minimally-invasive PN is associated with acceptable perioperative outcomes. The use of a robotic approach over a standard laparoscopic approach can be advantageous with respect to clinically relevant outcomes, and it should be preferred when available.
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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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