Category: Clinical Oncology: Outcomes & Complications

MP18-21 - Trifecta outcomes of partial nephrectomy in patients over 75 years old: a multi-institutional analysis of the REnal SURGery in Elderly (RESURGE) Group

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

To evaluate quality and functional outcomes of partial nephrectomy (PN) in elderly patients over (75 years old) using Trifecta as a composite outcome of surgical quality. PN utilization in the elderly is controversial due to concern regarding potential risks of procedure-specific complications.


Methods : Multicenter retrospective analysis of patients 75 years or older who underwent PN [REnal SURGery in Elderly (RESURGE) Group]. Primary outcome was achievement of Trifecta [negative surgical margin, no major (Clavien ≥3) urological complications, and ≥90% eGFR (glomerular filtration rate) recovery postoperatively].  The cohort was divided between patients who achieved Trifecta (Trifecta-pos) and patients who did not (Trifecta-neg) for descriptive analysis. Secondary outcomes included de novo chronic kidney disease (CKD) stage III and CKD upstaging at last follow-up. Multivariable analysis (MVA) was used to evaluate risk factors associated with achieving Trifecta and renal functional outcomes. Kaplan-Meier analysis (KMA) was used to calculate freedom from new onset CKD stage III and CKD upstaging.


Results :

We analyzed 653 patients (mean age 78.4 years, median follow-up 33 months, 382 open, 157 laparoscopic and 114 robotic PN). Trifecta-pos rate was 40.4% (n=264). No significant differences were noted in surgical approach (p=0.087) and mean ischemia time (p=0.109). Trifecta-pos patients had lower intraoperative transfusion rate (4.9% vs. 18.5%, p<0.001), lower intra- and postoperative complication rates (5.3% vs. 27%, p<0.001 and 25.4% vs. 37.8%, p=0.001, respectively), and shorter hospital stay (p=0.045). Trifecta-pos patients had lower change in eGFR (p<0.001), de novo CKD stage III (2% vs. 46.3%, p<0.001) and CKD upstaging (4.5% vs. 59.1%, p<0.001) at last follow-up. MVA for predictive factors for Trifecta demonstrated increasing R.E.N.A.L. score (OR 0.8, p=0.007) as less likely to achieve Trifecta. MVA for predictors for CKD upstaging showed warm ischemia time> 30 minutes (OR 2.8, p=0.048) and positive intraoperative transfusion (OR 2.7, p=0.043) as predictive factors for CKD upstaging and achievement of Trifecta (OR 0.04, p<0.001) as being negatively associated. KMA demonstrated that the Trifecta-pos group had improved 5-year freedom from de novo CKD Stage 3 (93.5% vs. 57.7%, p<0.001) and 5-year freedom from CKD upstaging (84.3% vs. 8.2%, p<0.001).


Conclusions :

PN in the elderly population can be performed with acceptable quality outcomes overall. Achievement of Trifecta, a composite of surgical quality, when applied to an elderly population was noted to be a predictor for favorable functional outcome.

Ithaar Derweesh

Professor of Urology and Radiology Program Director, Urologic Oncology Fellowship
Department of Urology, University of California San Diego School of Medicine
San Diego, California

Ahmet Bindayi

University of California San Diego
San Diego, California

Zachary Hamilton

University of California San Diego
St. Louis, Missouri

Umberto Capitanio

Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
Milan, Lombardia, Italy

Nicola Pavan

University of Trieste
Trieste, Friuli-Venezia Giulia, Italy

Maria Carmen Mir

Hospital del Mar Barcelona
Barcelona, Catalonia, Spain

Estefania Linares

University of Madrid
Madrid, Madrid, Spain

Toshio Takagi

Tokyo Women's Medical University
Tokyo, Tokyo, Japan

Koon Ho Rha

Professor
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
Seodaemun-gu, Seoul-t'ukpyolsi, Republic of Korea

Tobias Maurer

University of Munich
Munich, Bayern, Germany

Ryan Nasseri

University of California San Diego
Poway, California

Bo Yang

Shangai Hospital
Shanghai, Shanghai, China (People's Republic)

Francesco Montorsi

Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
Milan, Lombardia, Italy