Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group

• Published in: European urology focus Vol. 6; no. 5; pp. 982 - 990
• Main Authors: Bindayi, Ahmet, Autorino, Riccardo, Capitanio, Umberto, Pavan, Nicola, Mir, Maria Carmen, Antonelli, Alessandro, Takagi, Toshio, Bertolo, Riccardo, Maurer, Tobias, Ho Rha, Koon, Long, Jean−Alexandre, Yang, Bo, Schips, Luigi, Lima, Estevão, Breda, Alberto, Linares, Estefania, Celia, Antonio, De Nunzio, Cosimo, Dobbs, Ryan, Patel, Sunil, Hamilton, Zachary, Tracey, Andrew, Larcher, Alessandro, Trombetta, Carlo, Palumbo, Carlotta, Tanabe, Kazunari, Amiel, Thomas, Raheem, Ali, Fiard, Gaelle, Zhang, Chao, Castellucci, Roberto, Palou, Joan, Ryan, Stephen, Crivellaro, Simone, Montorsi, Francesco, Porpiglia, Francesco, Derweesh, Ithaar H.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.09.2020; Elsevier
• Subjects: Age Factors; Aged; Aged, 80 and over; Carcinoma; Chronic Kidney Disease; Elderly; Glomerular Filtration Rate; Humans; Kidney - physiology; Kidney Neoplasms - surgery; Life Sciences; Male; Margins of Excision; Nephrectomy - methods; Outcome Assessment; Partial Nephrectomy; Postoperative Complications - epidemiology; Renal Cell; Retrospective Studies; Treatment Outcome; Trifecta; Urologic Diseases - epidemiology; Carcinoma; Trifecta; Chronic Kidney Disease; Partial Nephrectomy; Elderly; Renal Cell; Outcome Assessment
• ISSN: 2405-4569; 2405-4569
• DOI: 10.1016/j.euf.2019.02.010

Partial nephrectomy (PN) in elderly patients is underutilized with concerns regarding risk of complications and potential for poor outcomes. To evaluate quality and functional outcomes of PN in patients >75 yr using trifecta as a composite outcome of surgical quality. Multicenter retrospective analysis of 653 patients aged >75 yr who underwent PN (REnal SURGery in Elderly [RESURGE] Group). PN. Primary outcome was achievement of trifecta (negative margin, no major [Clavien ≥3] urological complications, and ≥90% estimated glomerular filtration rate [eGFR] recovery). Secondary outcomes included chronic kidney disease (CKD) stage III and CKD upstaging. Multivariable analysis (MVA) was used to assess variables for achieving trifecta and functional outcomes. Kaplan-Meier survival analysis (KMA) was used to calculate renal functional outcomes. We analyzed 653 patients (mean age 78.4 yr, median follow-up 33 mo; 382 open, 157 laparoscopic, and 114 robotic). Trifecta rate was 40.4% (n=264). Trifecta patients had less transfusion (p<0.001), lower intraoperative (5.3% vs 27%, p<0.001) and postoperative (25.4% vs 37.8%, p=0.001) complications, shorter hospital stay (p=0.045), and lower ΔeGFR (p <0.001). MVA for predictive factors for trifecta revealed decreasing RENAL nephrometry score (odds ratio [OR] 1.26, 95% confidence interval 1.07–1.51, p=0.007) as being associated with increased likelihood to achieve trifecta. Achievement of trifecta was associated with decreased risk of CKD upstaging (OR 0.47, 95% confidence interval 0.32–0.62, p<0.001). KMA showed that trifecta patients had improved 5-yr freedom from CKD stage 3 (93.5% vs 57.7%, p<0.001) and CKD upstaging (84.3% vs 8.2%, p<0.001). Limitations include retrospective design. PN in elderly patients can be performed with acceptable quality outcomes. Trifecta was associated with decreased tumor complexity and improved functional preservation. We looked at quality outcomes after partial nephrectomy in elderly patients. Acceptable quality outcomes were achieved, measured by a composite outcome called trifecta, whose achievement was associated with improved kidney functional preservation. Partial nephrectomy in elderly patients provides quality outcomes as measured by trifecta. Tumor complexity is a key determinant for trifecta achievement, and trifecta attainment is associated with improved function. Increasing utilization of robotics has benefits in recovery without compromising quality.