Perioperative morbidity and renal function in young and elderly patients undergoing elective nephron-sparing surgery or radical nephrectomy for renal tumours larger than 4 cm.
OBJECTIVE
To analyse renal function, perioperative morbidity and overall survival (OS) in patients aged <55 years compared with patients aged > 65 years treated by radical nephrectomy (RN) or elective nephron-sparing surgery (NSS) for renal tumours > 4 cm.


METHODS
From our database, we identified 829 patients with renal tumours > 4 cm treated by either RN (n = 641) or NSS (n= 188) at our institution between 1981 and 2007. After excluding patients with imperative indication and metastases, we identified retrospectively 81 patients aged < 55 years (young patients) and 85 patients aged > 65 years (elderly patients) treated for renal tumours > 4 cm. In all, 36 and 33 patients underwent NSS and 45 and 52 patients underwent RN in the young and elderly group, respectively. Preoperative and periodically postoperative serum creatinin values were used to estimate glomerular filtration rate (GFR). Chronic kidney disease (CKD) was defined as GFR < 60 mL/min/1.73 m². Clinical characteristics, complications and renal function were compared between age groups and surgical approaches, and OS was estimated using the Kaplan-Meier method.


RESULTS
The median (range) tumour size in young patients was larger compared with that of elderly patients, i.e. 6 (4.2-14.0) cm vs 5 (4.2-16.0) cm, with P < 0.001 considered to be statistically significant. The complication rates did not differ between the age groups (P = 0.656) or between NSS and RN in young (P = 0.095) or elderly patients (P = 0.277). Chronic kidney disease after RN or NSS occurred in 31.1% and 15.5% for young patients, respectively and in 50.9% and 24.2% in elderly patients, respectively, until last available follow-up which was obtained after a median (range) of 5.69 (0.1-19.2) years for young patients and 5.48 (0.8-18.1) years for elderly patients. Overall survival did not significantly differ between NSS vs RN in young (P = 0.655) and elderly patients (P = 0.058).


CONCLUSIONS
Our findings suggest that performing NSS for tumours > 4 cm when feasible in young and carefully selected elderly patients is more beneficial for maintaining long-term renal function. Regardless of age, patients undergoing RN for renal tumours > 4 cm developed more new onsets of CKD than patients treated by elective NSS. The complication rate did not differ between the age groups or between types of surgery.
Roos
Frederik C
FC
Department of Urology, Medical Center, Johannes Gutenberg University, Mainz, Germany. frederik.roos@gmx.de
Brenner
Walburgis
W
Jäger
Wolfgang
W
Albert
Claudia
C
Müller
Melanie
M
Thüroff
Joachim W
JW
Hampel
Christian
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D009399:Nephrons / Q000502:physiology / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult