Mean features of the nephronsparing surgery in older patients with localized renal cell carcinoma

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Background. Imaging diagnostics becomes more widespread, the incidence of incidental renal cell carcinoma (RCC) among older adults is increasing each year. Although nephron-sparing surgery are the standard of care for localized RCC, the potential risk of perioperative complications and readmission rates are higher among older patients. Objective. To compare the main perioperative indicators, as well as oncological and functional results in the treatment of localized RCC in in older patients and middle-aged patients Materials and methods. From 2016 to August 2021 at the N.I. Pirogov Russian National Research Medical University on the basis of N.I. Pirogov City Clinical Hospital No. 1 we performed 134 laparoscopic PN. The 1st group included patients from 55 to 69 years old - 96 (71.6%) and 2nd group - 70 years and older - 38 (28.4%). The physical status was assessed according to the ASA (American Society of Anesthesiologists) classification and the Charlson comorbidity index (IC) was calculated. Glomerular filtration rate (GFR) was estimated using the MDRD (Modification of diet in renal disease) formula. Results. Length of the operation in patients in 1st group was 133.1 minutes. (60-250), in 2nd group 139.3 (50-240), the median time of warm ischemia was 12.4 (7-33) and 12.7 (6-22) minutes, the median blood loss volume was 123.3 and 135.1 ml, respectively. Complications, according to the Clavien-Dindo classification, were in 21 (21.9%) cases in patients front 55 to 69 years old and in 9 (23.7%) in patients 70 years and older. The median GFR for MDRD in the postoperative period for groups I and II was 57.4 and 50.5 ml/min/1.73 m2. The median follow-up time was 26 (4- 66) months. A positive surgical margin was observed in 2 (2.1%) cases in the 1st group and in 1 (2,6%) in 2nd group. The median follow-up time was 26 (4-66) months. Conclusion. Nephron-sparing surgery is safety in patients 70 years and older and the main intraoperative and oncological results are comparable to the group of middle-aged patients. Age itself is not a contraindication to surgical treatment.

Full Text

Restricted Access

About the authors

S. V Kotov

N.I. Pirogov Russian National Research Medical University Ministry of Health of Russia; N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Healthcare Department

Email: urokotov@mail.ru
M.D., Dr. Sc. (M), Full Prof.; Head of the department of urology and andrology faculty of medicine; Head; main specialist in urology in corporate group MEDCI Moscow, Russia; Moscow, Russia

A. A Nemenov

N.I. Pirogov Russian National Research Medical University Ministry of Health of Russia; S.S. Yudin City Clinical Hospital of the Moscow Healthcare Department

Email: nemenov.a@mail.ru
M.D., urologist; assistant of the department of urology and andrology faculty of medicine Moscow, Russia; Moscow, Russia

A. G Yusufov

N.I. Pirogov Russian National Research Medical University Ministry of Health of Russia; N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Healthcare Department

Email: anvar.yusufov@mail.ru
M.D., candidate ofmedical science, assistant professor of the department of urology and andrology faculty of medicine; urologist Moscow, Russia; Moscow, Russia

R. I Guspanov

N.I. Pirogov Russian National Research Medical University Ministry of Health of Russia; N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Healthcare Department

Email: doctorren@mail.ru
M.D., candidate of medical science, assistant professor of the department of urology and andrology faculty of medicine; urologist Moscow, Russia; Moscow, Russia

S. A Pulbere

N.I. Pirogov Russian National Research Medical University Ministry of Health of Russia; N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Healthcare Department

Email: pulpiv@mail.ru
M.D., Ph.D of the department of urology and andrology faculty of medicine; department chief Moscow, Russia; Moscow, Russia

D. M Nemenova

N.I. Pirogov Russian National Research Medical University Ministry of Health of Russia

Email: donata2011@bk.ru
Department of Urology and Andrology; student Moscow, Russia

References

  1. https://www.who.int/health-topics/ageing#tab=tab_1
  2. Male and female population in Russia as of January 1, 2021, by age group (in millions), https://www.statista.com/statistics/1005416/population-russia-gender-age-group/
  3. Lipworth L., Tarone R.E., & McLaughlin, J. K. (2006). The Epidemiology of Renal Cell Carcinoma. The Journal of Urology, 176(6), 2353-2358. doi: 10.1016/j.juro.2006.07.130
  4. Мерабишвили В.М., Полторацкий А.Н., Носов А.К. и др. Состояние онкологической помощи в России. Рак почки (заболеваемость, смертность, достоверность учета, одногодичная и погодичная летальность, гистологическая структура). Часть 1. Онкоурология 2021;17(2):182- 194). doi: 10.17650/1726-9776-2021-17-2-182-194.
  5. Volpe A. The role of active surveillance of small renal masses.Int J Surg. 2016;36:518-524.
  6. Kane C.J., Mallin K., Ritchey J., Cooperberg M.R., Carroll P.R. Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer 2008;113:78-83.
  7. Liss M.A., Wang S., Palazzi K. et al. Evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the American Urologic Associationguidelines for the management of clinical T1 renal masses. BMC Urol. 2014;14:101.
  8. Wunderle M.F., Härtel N., Wagener N., Kowalewski K.F., Nuhn P., Walach M.T., Kriegmair M.C. Prospective geriatric assessment for perioperative risk stratification in partial nephrectomy. European Journal of Surgical Oncology. 2020. doi: 10.1016/j.ejso.2020.11.001.
  9. Morgia G., Russo G.I., Berretta M., Privitera S., Kirkali Z. Genito-urological cancers in elderly patients. Anticancer Agents Med Chem 2013;13:1391-1405.
  10. Abu-Ghanem Y., Dhesi J.K., Challacombe B.J. The challenges of managing urological malignancy in the elderly. BJU Int 2014;114:12-15.
  11. Tomaszewski J.J., Kutikov A. Small renal mass management in the elderly and the calibration of risk. Urol Oncol 2015;33:197-200.
  12. Mirza M. Management of small renal masses in the older adult. Clinics Geriatr Med 2015;31:603-613.
  13. Roos F.C., Hampel C., Thuroff J.W. Renal cancer surgery in the elderly. Curr Opin Urol 2009;19:459-464.
  14. Cheung D.C., Finelli A. Active Surveillance in Small Renal Masses in the Elderly: A Literature Review. European Urology Focus. 2017;3(4-5):340- 351. doi: 10.1016/j.euf.2017.11.005.
  15. Kutikov A., Egleston B.L., Wong Y.N., Uzzo R.G. Evaluating overall survival and competing risks of death in patients with localized renal cell carcinoma using a comprehensive nomogram. J Clin Oncol 2010;28:311-317.
  16. Abouassaly R. Yang S., Finelli A., Killkarni G.S., Alibhai S.M. What is the best treatment strategy for incidentally detected small renal masses? A decision analysis. BJU Int 2011; 108:E223-231.
  17. Hillyer S.P., Autorino R., Spana G., et al. Perioperative outcomes of robotic-assisted partial nephrectomy in elderly patients: a matched-cohort study. Urology. 2012;79:1063-1067.
  18. Матвеев В.Б., Матвеев Б.П., Волкова М.И., Перлин Д.В., Фигурны K.M. Роль органосохраняющего хирургического лечения рака почки на современном этапе. Онкоурология. 2007;3(2):5). https://doi.org/10.17650/1726-9776-2007-0-2-5-11
  19. Ракул C.A., Поздняков K.B., Елоев P.A. Осложнения робот-ассистированных и лапароскопических резекций почек. Онкоурология. 2021 ;17(2):34-45). doi: 10.17650/1726-9776-2021-172-34-45.
  20. Becker A., Roghmann F., Ravi P., et al. Delay in nephrectomy and cancer control outcomes in elderly patients with small renal masses. Urol Int. 2014;92:455-461.
  21. Volpe A., Cadeddu J.A., Cestari A., et al. Contemporary management of small renal masses. Eur Urol. 2011;60:501-515.
  22. Deklaj F., Lifshitz D.A., Shikanov S.A., et al. Localized Tla renal lesions in the elderly: outcomes of laparoscopic renal surgery. J Endourol. 2010;24:397-401.
  23. Thomas A.A., Aron М., Hernandez A.V., et al. Laparoscopic partial nephrectomy in octogenarians. Urology. 2009:74:1042-1046.
  24. Bufalari A., Ferri М., Cao P., et al. Surgical care in octogenarians. Br J Surg. 1996;83:1783-1787.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies