title: Cytoreductive nephrectomy in the elderly patient: the M. D. Anderson Cancer Center experience.
abstract: OBJECTIVE
  Cytoreductive nephrectomy as part of a multidisciplinary approach may be considered in patients with metastatic renal cell carcinoma. The benefit in the elderly population (75 years or older) is unclear. We reviewed our experience to help determine if it is of benefit in this patient population.
  
  
  METHODS
  Of 404 patients undergoing cytoreductive nephrectomy from 1995 and 2005 we identified 24 elderly patients. Outcomes in these elderly patients were analyzed and compared to outcomes in the remaining 380 who were younger than 75 years.
  
  
  RESULTS
  Median age in the elderly and younger groups was 77.5 and 57.0 years, respectively. Performance status, sex distribution, and tumor histology, stage, grade and size were comparable. Estimated blood loss, transfusion rates, surgical times and hospital stay were similar in the 2 groups. There were 5 perioperative deaths (21%) in elderly patients compared to 4 (1.1%) in younger patients (p<0.01). Estimated blood loss, units transfused and surgical time were greater in the patients who died perioperatively (p<0.05). Median survival was 16.6 months in the elderly group, which did not differ statistically from the 13.7 months in the younger group.
  
  
  CONCLUSIONS
  Cytoreductive nephrectomy in the elderly population can be associated with the potential for significant morbidity and mortality. Despite this and as part of a multidisciplinary approach it may provide potential survival as well as other benefits, which may justify it in highly select and highly motivated patients who are 75 years or older. However, it must be performed carefully with realistic expectations on behalf of the patient and urologist.
authors.affiliation: Department of Urology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: A Karim
authors.initials: AK
authors.lastname: Kader
authors.forename: Pheroze
authors.initials: P
authors.lastname: Tamboli
authors.forename: Tony
authors.initials: T
authors.lastname: Luongo
authors.forename: Surena F
authors.initials: SF
authors.lastname: Matin
authors.forename: Kayla
authors.initials: K
authors.lastname: Bell
authors.forename: Eric
authors.initials: E
authors.lastname: Jonasch
authors.forename: David A
authors.initials: DA
authors.lastname: Swanson
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome