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Comparing Outcomes in Elderly Patients after Laparoscopic Radical Nephrectomy, Open Partial Nephrectomy and Cryoablation for Renal Masses
Jack W Lambert, III, Stephen Riggs, Joshua Logan, Dave Staneck, Mary Francis James, Bethany Barone
EVMS, Norfolk, VA
Introduction and Objective:
There is minimal research comparing morbidity and mortality in elderly patients undergoing various types of treatment for renal cell carcinoma (RCC). This study compares open partial nephrectomy (OPN), laparoscopic radical nephrectomy (LN) and cryoablation (CA) in patients 70 years or older and evaluates outcomes between these cohorts.
Methods:
We performed a retrospective review using our RCC database of 500 patients from 2001-2009. Inclusion criteria were any patient older than 70 years of age who underwent OPN, LN, or CA. 101 patients were identified of which 28, 38 and 35 had OPN, LN, or CA, respectively.
Results:
Recurrence free survival (RFS) for the entire cohort was 98.0%, overall survival (OS) was 88.1%, and cancer specific survival (CSS) was 98.0%. The average follow up was 25.3 months. Only one patient (in the LN cohort) required hemodialysis (HD). The mean percentage decrease from pre to post-operative glomerular filtration rate (GFR) for OPN, LN and CA were 7%, 33%, and 10.7% respectively. The complication rates were 78.6%, 36.7%, and 31.4% in the OPN, LN, and CA cohorts, respectively.
Conclusions:
Our data suggests that patients 70 years or older who undergo partial nephrectomy experienced increased morbidity given their higher complication rate. Only one patient in the LN cohort went on to require HD, questioning the ultimate benefit of nephron sparing surgery in this age group.
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