Clinical Oncology: Outcomes & Complications

Moderated Poster Session

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

Saturday, September 22
10:00 AM - 12:00 PM
Location: Room 253

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

Presentation(s):

    Send Email for Ithaar Derweesh

    Ahmet Bindayi

    University of California San Diego

    Presentation(s):

      Send Email for Ahmet Bindayi

      Zachary Hamilton

      University of California San Diego

      Presentation(s):

        Send Email for Zachary Hamilton

        Umberto Capitanio

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

        Presentation(s):

          Send Email for Umberto Capitanio

          Nicola Pavan

          University of Trieste

          Presentation(s):

            Send Email for Nicola Pavan

            Maria Carmen Mir

            Hospital del Mar Barcelona

            Presentation(s):

              Send Email for Maria Carmen Mir

              Estefania Linares

              University of Madrid

              Presentation(s):

                Send Email for Estefania Linares

                Toshio Takagi

                Tokyo Women's Medical University

                Presentation(s):

                  Send Email for Toshio Takagi

                  Koon Ho Rha

                  Professor
                  Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea

                  Dr. Koon Ho Rha is Professor of Urology and Robotic and Minimally Invasive Surgery Center. He received both his premedicine education magna cum laude and his M.D. degree from the Yonsei University, Seoul. He underwent fellowship training in minimally invasive and laparoscopic surgery at the Johns Hopkins Medical Institution as Engineering and Urology endowed fellow, and served as visiting Assistant Professor in Urology at the Johns Hopkins University School of Medicine. During his stay, he also completed “Business in Medicine” a 1-year MBA program at the School of Business Administration and Education.
                  At Johns Hopkins, he continued his interests in the field of minimally invasive surgery/laparoscopy, and conducted further scientific studies with Dr. Louis R. Kavoussi, the leading pioneer on laparoscopic and robotic surgery. Dr. Rha set up the robotic surgery program at Yonsei University in 2005 which now became the most successful robotic program in the world with more than 21,000 cases. During last 10 years, Dr. Rha has performed the most robotic urological cases in Asia with more than 2800 cases of robotic cases including some 2500 cases of robotic prostatectomies. With cumulative experiences, Dr. Rha’s team developed world’s first robotic approaches of nephroureterectomies and single-incision partial nephrectomies. He has given more than 500 lectures on robotic surgery. He also performed live surgery or proctored more than 60 occasions, including US, France, Italy, Czech Republic, China, Japan, Taiwan, Singapore, Hong Kong, Saudi Arabia, Thailand and Malaysia. With interest in developing surgical robotic platform and devices, Dr. Rha lead the development Korean surgical (Revo-I, MeereCompany) since 2007 and successfully finished first human trial on robotic prostatectomy in 2017.

                  Presentation(s):

                    Send Email for Koon Ho Rha

                    Tobias Maurer

                    University of Munich

                    Presentation(s):

                      Send Email for Tobias Maurer

                      Ryan Nasseri

                      University of California San Diego

                      Presentation(s):

                        Send Email for Ryan Nasseri

                        Bo Yang

                        Shangai Hospital

                        Presentation(s):

                          Send Email for Bo Yang

                          Francesco Montorsi

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

                          Presentation(s):

                            Send Email for Francesco Montorsi


                            Assets

                            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



                            Attendees who have favorited this

                            Please enter your access key

                            The asset you are trying to access is locked. Please enter your access key to unlock.

                            Send Email for 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