Impact of frailty on perioperative and oncologic outcomes in patients undergoing surgery or ablation for renal cancer: a systematic review

Campi, Riccardo; Berni, Alessandro; Amparore, Daniele; Bertolo, Riccardo; Capitanio, Umberto; Carbonara, Umberto; Erdem, Selçuk; Ingels, Alexandre; Kara, Önder; Klatte, Tobias; Kriegmair, Maximilian C.; Marchioni, Michele; Minervini, Andrea; Mir, Maria Carmen; Papalia, Rocco; Pavan, Nicola; Pecoraro, Angela; Rivas, Juan Gómez; Rivasi, Giulia; Roussel, Eduard; Ungar, Andrea; Serni, Sergio; Esperto, Francesco

doi:10.23736/s2724-6051.21.04583-3

Cited by 41 publications

(11 citation statements)

References 53 publications

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“…The transplantation outcome depends on patient demographic characteristics, comorbidity, and competing risks of mortality. Frailty has been consistently associated with worse outcomes after surgery for RCC ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…Coupled with a previous study, a delay after curative treatment did not appear to protect against cancer recurrence ( 33 ). Even if contraindication and a delayed waiting time of transplantation were not encouraged, preoperative frailty and oncology assessment to identify patients who are expected to benefit most from transplantation, aiming to optimize decision-making and postoperative outcomes in RCC-induced ESRD patients, are needed ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

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Transplant or dialysis: What’s the better choice for RCC-induced ESRD patients? A 20-year analysis of OPTN/UNOS data

Hao

Lai²,

Xia³

et al. 2022

Front. Oncol.

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PurposeThe incidence of end-stage renal disease (ESRD) caused by renal cell carcinoma (RCC) is increasing with the high prevalence of RCC as well as those with treatment-related renal function impairment. Worries about tumor recurrence after transplant-related immunosuppression hinder the recommendation of kidney transplantation for RCC-induced ESRD patients. However, no direct analysis has been performed to identify whether kidney transplantation can offer better survival than maintaining dialysis.Materials and methodsThis retrospective population-based cohort study was based on Organ Procurement and Transplantation Network data released in March 2021. Characteristics and outcomes were compared, including the patient and graft survival of candidates and recipients with RCC-induced ESRD etiology as well as other primary diseases.ResultsPatients with RCC-induced ESRD were older; more likely to be male, White, and obese; and more likely to have a history of diabetes and dialysis. They also had higher creatinine levels, more delayed graft function, more primary non-function, and higher Kidney Donor Profile Index score donors, compared with the glomerulonephritis (GN) group. While waiting, RCC candidates suffered the worst outcomes of all groups, a 44% (adjusted hazard ratio [aHR], 1.44 [1.27–1.62]) higher risk of removal than GN patients. After transplantation, RCC recipients demonstrated comparable patient survival and better graft survival (p=0.21 and p=0.13, respectively). Compared with still-waiting RCC patients, the RCC recipients who received kidney transplants had significantly better outcomes (13.6 [9.3–17.8] vs. 61 [52–68.4] %), decreasing the death or deteriorating risk by 84% (aHR, 0.16 [0.13–0.20]).ConclusionsPatients with RCC-induced ESRD can dramatically benefit from kidney transplantation. Hence, these patients should not be limited to transplantation by strict strategies or a delayed waiting time out of their malignancy history.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transplant or dialysis: What’s the better choice for RCC-induced ESRD patients? A 20-year analysis of OPTN/UNOS data

Hao

Lai²,

Xia³

et al. 2022

Front. Oncol.

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“…Ablative therapies are becoming more popular in managing SRMs, especially due to the increasing age of affected individuals and associated co-morbidities including frailty that may potentially deem them high risk or not suitable to receive general anaesthesia (GA). 1 , 24 , 25 Current data suggest that thermal ablative therapies may have a similar rate of local recurrence compared to PN in T1aN0M0 tumours, however; this may not be accurate for T1b tumours and there is the risk of selection bias when comparing against patients fit for surgery. 5 , 26 – 30 Thermal ablative therapies are not suitable for use on centrally located renal tumours, due to the potential risk of damaging the collecting system and the risk of heat sink.…”

Section: Discussionmentioning

confidence: 99%

Irreversible electroporation in renal tumours: A systematic review of safety and early oncological outcomes

2022

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We review the safety and early oncological outcomes of irreversible electroporation (IRE), a novel non-thermal ablation technique, in small renal masses (SRMs). Following PROSPERO registration (CRD42020197943), a systematic search of MEDLINE, EMBASE and SCOPUS databases according to PRISMA guidelines was performed. Critical appraisal of the included studies was performed using the Newcastle-Ottawa Scale. Of 224 articles screened, 10 met the inclusion criteria. In total, 83 patients were identified. Except for one cohort study ( n = 41), the remaining studies were case series of n < 10. Follow up was <12 months in 7/10 articles (range 3–34 months). About 10/10 articles reported safety outcomes. There were no 30-day mortalities. The most frequently reported adverse events were transient haematuria (11/83) and asymptomatic perirenal haematomas (7/83). About 62/63 patients with reported length of stay were discharged within 24 h. No significant long-term changes in renal function were reported. About 7/10 articles reported oncological outcomes. Only one article assessed histopathological outcomes, whilst the remaining studies used cross-sectional imaging modalities to assess efficacy, recurrence or disease progression. About 4/7 patients with histopathology outcomes, showed complete response (CR). About 43/55 patients with radiological outcomes showed CR. No mortalities were reported due to SRMs. These initial findings support IRE as safe and feasible in managing SRMs. However, results from larger studies with longer follow-up are needed to evaluate oncological outcomes and compare these with other ablation methods.

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“…We found that patients receiving PCA were significantly older and had worse performance status and more severe comorbidity than patients receiving PN. In addition, patient frailty has been reported to impact perioperative and oncological outcomes [33] . Therefore, preoperative frailty assessment could optimize patient outcomes and is a factor to consider in decision-making.…”

Section: Discussionmentioning

confidence: 99%

Impact of Partial Nephrectomy and Percutaneous Cryoablation on Short-term Health-related Quality of Life—A Prospective Comparative Cohort Study

Junker

Duus²,

Rasmussen³

et al. 2022

European Urology Open Science

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Impact of frailty on perioperative and oncologic outcomes in patients undergoing surgery or ablation for renal cancer: a systematic review

Cited by 41 publications

References 53 publications

Transplant or dialysis: What’s the better choice for RCC-induced ESRD patients? A 20-year analysis of OPTN/UNOS data

Transplant or dialysis: What’s the better choice for RCC-induced ESRD patients? A 20-year analysis of OPTN/UNOS data

Irreversible electroporation in renal tumours: A systematic review of safety and early oncological outcomes

Impact of Partial Nephrectomy and Percutaneous Cryoablation on Short-term Health-related Quality of Life—A Prospective Comparative Cohort Study

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