title: A nonrandomized prospective comparison of robotic-assisted partial nephrectomy in the elderly to a younger cohort: an analysis of 339 patients with intermediate-term follow-up.
abstract: OBJECTIVE
  To assess the role of robotic-assisted partial nephrectomy (RAPN) in elderly patients focusing on perioperative, functional, and oncologic outcomes in comparison with a younger cohort.
  
  
  METHODS
  From a prospectively maintained institutional review board-approved database, 339 patients were divided into 2 groups defined by age ≥ 70 (n = 71) or <70 years (n = 268) at the time of RAPN. They were compared for perioperative outcomes and complications, including risk of chronic kidney disease (CKD) stage progression. The standard t test and chi square test were used for continuous and categorical variables, respectively. Logistic regression identified risk factors for progression of renal dysfunction. Kaplan-Meier estimates modeled tumor recurrence at 368 and 462 days in the elderly and young, respectively.
  
  
  RESULTS
  Elderly patients were more likely to have hypertension (86% vs 60%; P < .001) or coronary artery disease (27% vs 9%; P < .001), and rates of chronic obstructive pulmonary disorder and diabetes were also higher. Preoperative estimated glomerular filtration rate was significantly lower in the elderly (70 vs 82 mL/min/1.73 m2; P < .001). Twenty-four percent of elderly patients progressed in CKD stage as compared to 14% in the younger cohort (P = .08). Elderly age was not a statistically significant risk factor for CKD progression (relative risk, 2.34; 95% confidence interval, 0.81-6.05; P = .11). Surgical and medical complication rates were similar between the cohorts (P = .75 and .80, respectively) as were Kaplan-Meier estimates of risk of tumor recurrence (P = .47). Limitations include nonrandomized, single-center study, and intermediate-term follow-up for oncologic outcomes.
  
  
  CONCLUSIONS
  Elderly patients undergoing RAPN had no increased risk of perioperative complications. CKD progression and risk of oncologic recurrence were similar to younger patients at intermediate-term follow-up.
authors.affiliation: Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Sandberg
authors.affiliation: Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Louis Spencer
authors.initials: LS
authors.lastname: Krane
authors.affiliation: Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC. Electronic address: ahemal@wakehealth.edu.
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Hemal
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D013997:Time Factors; D055815:Young Adult