Русский
Mean features of the nephron- sparing surgery in older patients with localized renal cell carcinoma
DOI: https://dx.doi.org/10.18565/urology.2022.6.84-88
S.V. Kotov, A.A. Nemenov, A.G. Yusufov, R.I. Guspanov, S.A. Pulbere, D.M. Nemenova
1) Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia; 2) N.I. Pirogov City Clinical Hospital No. 1 of the Moscow Healthcare Department, Moscow, Russia; 3) S.S. Yudin City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia
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 from 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.
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 from 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.
Keywords: older patients, nephron-sparing surgery, kidney tumor, laparoscopic partial nephrectomy, renal cell carcinoma
About the Autors
Contact author: A.A. Nemenov – M.D., urologist at the S.S. Yudin City Clinical Hospital of the Moscow Healthcare Department, assistant of the department of urology and andrology faculty of medicine, N.I. Pirogov RNRMU, Moscow, Russia; e-mail: nemenov.a@mail.ru
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