Safety and outcomes of surgical treatment of renal cell carcinoma in the elderly.
BACKGROUND
Treatment of the elderly patient with a small renal mass is becoming a common conundrum with scant data available to support treatment decisions. Goals were to assess risk of surgical treatment for renal cell carcinoma (RCC) in the elderly as compared to their younger counterparts.


METHODS
A prospectively maintained database consisting of all renal tumors between August 2004 and November 2009 was utilized. Patients who underwent extirpative treatment for RCC were divided into groups based on age cutoff of < 75 and ≥ 75 years old. Primary outcome measures were likelihood of partial nephrectomy versus radical nephrectomy, complication rates, and overall and cancer-specific survival. A secondary outcome investigated was renal function.


RESULTS
Of 347 patients identified, 273 were < 75, and 74 were ≥ 75 years old. The elderly group was less likely to undergo partial nephrectomy (26% versus 43%, p = 0.045). They also had a higher rate of pT3 disease (20% versus 11%, p = 0.018), worse baseline renal function (46 mL/min/m(2) versus 92 mL/min/m(2), p < 0.001) and a longer length of stay (3.5 days versus 2.2 days, p < 0.001). Complication rates and survival outcomes were similar between the groups. Only Eastern Cooperative Oncology Group (ECOG) ≥ 1 and Charlson index ≥ 2 predicted likelihood of experiencing a complication.


CONCLUSIONS
Despite a longer length of stay, renal surgery is safe in selected elderly patients with minimal comorbidity and good functional status. The elderly have reduced baseline renal function indicating nephron sparing should be chosen whenever possible, when surgical intervention is elected.
Department of Urology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Rebecca L
RL
O'Malley
Matthew H
MH
Hayn
Nicholas J
NJ
Hellenthal
Hyung L
HL
Kim
Willie
W
Underwood
Thomas
T
Schwaab
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D016896:Treatment Outcome