MP21: Kidney Cancer: Localized: Surgical Therapy III
MP21-20: The impact of ischemia on chronic kidney disease progression after robotic partial nephrectomy in patients over 75 years old: results of a multi-institutional collaborative series (ROSULA)
Friday, May 15, 2020
7:00 AM – 9:00 AM
Umberto Anceschi, Aldo Brassetti, Gabriele Tuderti, Andrea Minervini , Andrea Mari, Antonio Andrea Grasso, Marco Carini, Umberto Capitanio, Alessandro Larcher, Francesco Montorsi, Riccardo Autorino , Alessandro Veccia, Daniele Amparore, Francesco Porpiglia, Ithar Deerwesh, Daniel Eun, Jennifer Lee, Michele Gallucci, Giuseppe Simone
Introduction: Partial nephrectomy (PN) in elderly patients (over 75 years) is certainly underused with concerns regarding risk of major complications and a negligible impact on renal function. The aim of this study was to compare the progression to chronic kidney disease (CKD) of purely off-clamp vs on-clamp robotic partial nephrectomy in patients = 75 years in a multinstitutional series.
Methods: A collaborative multicentric renal surgery dataset (ROSULA) was queried for “partial nephrectomy” and “age=75 years”. Between May 2008 and October 2019, a total of 207 patients who underwent robotic partial nephrectomy (RAPN) matched the inclusion criteria. Newly onset of any CKD stage (3a,3b,4,5) after surgery was computed by Kaplan-Meier curve and compared for surgical approach (purely-off clamp vs on-clamp) with the log-rank test. Univariable and multivariable Cox regression analyses were performed to identify predictors of CKD progression. For all statistical analyses, a two-sided p < 0.05 was considered significant.
Results: Mean age of the cohort considered was 77 years (IQR 76-81). At a median follow-up of 25 months (IQR 12-42.2) newly onset of CKD-3a and CKD-3b stages were observed in 7.2% and 8.7% of patients, respectively. At Kaplan-Meier analysis, on-clamp approach was associated with a significantly higher risk of developing a CKD progression, while a purely-off clamp approach was associated with a significantly lower risk of renal decline in patients = 80 years old. (Figure 1; p=0.04 - Figure 2; p=0.03). On univariable analysis surgical approach (HR 4.22 – 95% CI 1.52-11.6; p=0.006) warm ischemia time (HR 1.05 – 95% CI 1.02-1.08; p=0.01) and tumor size (HR 1.05 -95% CI 1.01-1.09) were all significant predictors of renal function decline. On multivariable analysis warm ischemia time (HR 1.04 – 95% CI 1.01-1.08; p=0.006) was the only independent predictor of any CKD stage progression.
Conclusions: Robotic partial nephrectomy in the elderly population may achieve acceptable mid-term functional outcomes. Ischemia time during robotic partial nephrectomy remains the only modifiable surgical factor to avoid a significant progression of CKD even at the oldest age. Source of