title: Perioperative outcomes of robotic-assisted partial nephrectomy in elderly patients: a matched-cohort study.
abstract: OBJECTIVE
  To compare elderly patients undergoing robotic assisted partial nephrectomy (RAPN) with a match cohort of younger patients. Investigating the benefits of minimally invasive RAPN including faster convalescence and decreased postoperative narcotic use make this an attractive option in patients with advanced age and numerous comorbidities.
  
  
  METHODS
  A retrospective review of 250 consecutive patients who underwent robotic-assisted partial nephrectomy (RAPN) for a solitary renal tumor from June 2006 to May 2010 at our institution was performed. Thirty-seven patients ≥ 70 years (G70) who underwent 38 robotic partial nephrectomy (RPN) procedures were identified. This group was matched with 38 patients <70 years (L70) who underwent 38 RPN procedures at our institution. Functional, perioperative, and oncological outcomes of RAPN in patients ≥ 70 years old were analyzed.
  
  
  RESULTS
  Overall, the median tumor size was 2.65 cm. Tumor characteristics, renal function, nephrometry score, and incidence of renal cancer in lesions were similar between the L70 and G70 groups. The two groups showed no differences in American Society of Anesthesiologists scores of 1-4 or Charlson comorbidity index score. Perioperative and postoperative outcomes showed no variation between L70 and G70 patients. Postoperative complications rate of 21% and 31.6% in the L70 and G70 groups, respectively, showed no difference (P < .48). There were 5 deaths, 3 of which occurred in the G70 group (8.1%) at a median of 22 months after surgery.
  
  
  CONCLUSIONS
  RAPN for small renal masses offers a safe alternative for patients >70 years of age, with no increase in perioperative and postoperative morbidity and mortality. Age may not be predictive of perioperative complications.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Shahab P
authors.initials: SP
authors.lastname: Hillyer
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Gregory
authors.initials: G
authors.lastname: Spana
authors.forename: Julien
authors.initials: J
authors.lastname: Guillotreau
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome