Treating renal cell cancer in the elderly.
OBJECTIVE
To determine whether age and comorbidity are predictors of peri-operative complications and/or mortality in surgery for renal cell cancer in a retrospective study of patients aged >75 years.


METHODS
Between 1993 and 2003, 1023 radical nephrectomies or nephron-sparing surgery for renal cell cancer were performed in 115 consecutive patients aged > or = 75 years and in 908 consecutive patients aged <75 years. The preoperative American Society of Anesthesiologists (ASA) score was used for risk stratification. Operative mortality and early complications (within 30 days of surgery) were reviewed.


RESULTS
The younger patients had significantly lower ASA scores than the older patients. There were early complications in 31 of the 908 younger patients (3.4%) and in two of the 115 older patients (1.7%). Peri-operative mortality was higher in the older than in the younger patients (1.7% vs 0.3%; P = 0.29). Overall morbidity and mortality correlated with increasing ASA score but not with age (P < 0.05).


CONCLUSIONS
Despite greater comorbidity in older patients, their morbidity and mortality did not differ significantly from that of younger patients. Advanced age alone should thus not be used as a criterion to deny surgery for renal cell carcinoma. However, older patients should be counselled regarding a tendency for increased comorbidity-related peri-operative mortality.
Department of Urology, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstrasse 74, D-01309 Dresden, Germany.
Navid
N
Berdjis
Oliver W
OW
Hakenberg
Vladimir
V
Novotny
Michael
M
Froehner
Manfred P
MP
Wirth
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome