title: Partial vs Radical Nephrectomy for T1-T2 Renal Masses in the Elderly: Comparison of Complications, Renal Function, and Oncologic Outcomes.
abstract: OBJECTIVE
  To compare outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in patients 65 years and older.
  
  
  METHODS
  Our institutional renal mass registry was queried for patients 65 and older with solitary cT1-T2 renal mass resected by PN or RN. Clinicopathologic features and perioperative outcomes were compared between groups. Renal function outcomes measured by change in estimated glomerular filtration rate (eGFR) and freedom from eGFR< 45 mL/min/1.73 m2were analyzed. Multivariate Cox proportional hazard models for overall survival and cancer-specific survival were analyzed.
  
  
  RESULTS
  Overall, 787 patients met inclusion criteria. Of these, 437 (55.5%) underwent PN and 350 (44.5%) underwent RN. Median follow-up was 36 months. Patients in the PN cohort were younger (median age 70.3 years vs 71.9 years, P < .001), had lower American Society of Anesthesiologists scores (2.6 vs 2.8, P = .001), smaller tumors (tumor diameter 2.8 cm vs 5.0 cm, P < .001), and lower proportion of renal cell carcinoma (76.7% vs 87.4%, P < .001). Perioperative outcomes were similar between PN and RN groups as were complications (37.8% vs 38.9%). Estimated change in eGFR was less in PN vs RN (6.4 vs 19.7, P < .001) at last follow-up. Overall survival and cancer-specific survival were equivalent between modalities.
  
  
  CONCLUSIONS
  Because the renal functional benefit of PN is realized over many years and the procedure has a higher historical complication rate than RN, some suspected elderly patients might benefit more from RN over PN. However, these data suggest that elderly patients are not harmed and may potentially benefit from PN. Age alone should not be a contraindication to nephron-sparing surgery.
authors.affiliation: Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Julie Y
authors.initials: JY
authors.lastname: An
authors.affiliation: Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: mark.ball@jhmi.edu.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ball
authors.affiliation: Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gorin
authors.affiliation: Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Jiwon J
authors.initials: JJ
authors.lastname: Hong
authors.affiliation: Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Johnson
authors.affiliation: Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Pavlovich
authors.affiliation: Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Mohamad E
authors.initials: ME
authors.lastname: Allaf
authors.affiliation: Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Pierorazio
mesh_terms: D000367:Age Factors; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000453:epidemiology*; D012189:Retrospective Studies