Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group

Bindayı, Ahmet; Autorino, Riccardo; Capitanio, Umberto; Pavan, Nicola; Mir, Maria Carmen; Antonelli, Alessandro; Takagi, Toshio; Bertolo, Riccardo; Maurer, Tobias; Rha, Koon Ho; Long, Jean-Alexandre; Yang, Bo; Schips, Luigi; Lima, Estêvão; Breda, Alberto; Linares, Estefanía; Celia, Antonio; Nunzio, Cosimo De; Dobbs, Ryan W.; Patel, Sunil; Hamilton, Zachary; Tracey, Andrew; Larcher, Alessandro; Trombetta, Carlo; Palumbo, Carlotta; Tanabe, Kazunari; Amiel, Thomas; Raheem, Ali Abdel; Fiard, G.; Zhang, Chao; Castellucci, Roberto; Palou, Joan; Ryan, Stephen; Crivellaro, Simone; Montorsi, Francesco; Porpiglia, Francesco; Derweesh, Ithaar

doi:10.1016/j.euf.2019.02.010

Cited by 26 publications

(16 citation statements)

References 28 publications

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“…We found that patients with SLE had acceptable outcomes in terms of intra-and postoperative complications and immediate and medium-term renal function impairment. These rates are comparable with those reported by the RESURGE group that analyzed the trifecta and functional outcomes after PN in patients with >75 years [12]. In detail, the overall intraoperative and postoperative complications rates were 6.7% and 16.1%; the positive SM rate was 3.7%; and the mean DeGFR was −3.4 § 11.3 ml/min [12].…”

Section: Discussionsupporting

confidence: 83%

Is partial nephrectomy safe and effective in the setting of frail comorbid patients affected by renal cell carcinoma? Insights from the RECORD 2 multicentre prospective study

Mari

Marra²,

Nazzani

et al. 2021

Urologic Oncology: Seminars and Original Investigations

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Background: To investigate the perioperative and morbidity outcomes after partial nephrectomy (PN) in patients with short life expectancy (SLE) (≥95% 10-year expected mortality (10y-EM)), to assess the main predictors of outcomes in this population and to compare these results with those of a group at the opposite upper range with long LE (LLE, ≤5% 10y-EM) relying on a multicenter Italian prospective registry of kidney surgery (the RECORD 2 project).Methods: Clinical data of 4,325 patients undergone kidney surgery were collected at 26 urological Italian Centers from 2013 to 2016. SLE was defined as a ≥95% 10y-EM (assessed using the age-adjusted Charlson comorbidity index [CCI]). A multivariable logistic regression for overall postoperative complications, acute kidney injury (AKI), positive surgical margins (SM) and Δ estimated glomerular

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Section: Discussionsupporting

confidence: 83%

Is partial nephrectomy safe and effective in the setting of frail comorbid patients affected by renal cell carcinoma? Insights from the RECORD 2 multicentre prospective study

Mari

Marra²,

Nazzani

et al. 2021

Urologic Oncology: Seminars and Original Investigations

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“…8,9 furthermore, recent evidence suggests that the "oldest old" patients might benefit of PN in terms of surgical functional outcomes, and oncological safety. [10][11][12][13] However, the rate of elderly patients who underwent PN for large renal mass (cT1b or ≥cT2) in these studies was underrepresented. Moreover, available evidence on robotic radical nephrectomy (rrN) in elderly patients is poor and scarce and without adequate comparison to rPN.…”

Section: Discussionmentioning

confidence: 99%

Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses

Veccia

Dell’Oglio

Antonelli

et al. 2020

Minerva Urol Nefrol

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BACKGROUND: Recent evidence suggests that the "oldest old" patients might benefit of partial nephrectomy (PN), but decision-making for this subset of patients is still controversial. aim of this study is to compare outcomes of robotic partial (rPN) or radical nephrectomy (rrN) for large renal masses in patients older than 65 years. METHODS: We identified 417≥65 years old patients who underwent RRN or RPN for cT1b or ≥cT2 renal mass at 17 high volume centers. Propensity score match analysis was performed adjusting for age, ASA≥3, pre-operative eGFR, and clinical tumor size. Predictors of complications, functional and oncological outcomes were evaluated in multivariable logistic and cox regression models. reSUlTS: after propensity score analysis, 73 patients in the rPN group were matched with 74 in the rrN group. r.e.N.a.l. Score (9.6±1.7 vs. 8.6±1.7; P<0.001), and high complexity (56 vs. 15%; P=0.001) were higher in the rrN. estimated blood loss was higher in the rPN group (200 vs. 100 ml; P<0.001). rPN showed higher rate of overall complications (38 vs. 23%; P=0.05), but not major complications (P=0.678). at last follow-up, rPN group showed better

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“…This is probably due to the low numbers of these in the present study. Whilst many studies have found a correlation between both the PADUA and RENAL nephrometry scoring systems and complications [4–8,18], several others have not [9,11,19–21]. Only one reviewed paper found a correlation with PSM status [19].…”

Section: Discussionmentioning

confidence: 99%

“…A multi‐institutional retrospective review comparing the outcomes of 1185 RAPNs and 646 laparoscopic PNs found an association on multivariate analysis between RENAL score and the trifecta when comparing high‐ and low‐complexity tumours ( P = 0.037) [22]. Bindayi et al [18] analysed the causes and effects of the trifecta in a multicentre retrospective review of 653 patients aged >75 years from the RESURGE group (renal surgery in elderly). They found that the RENAL score was significantly higher in cases not achieving the trifecta, but only by a mean score of 0.4 (6.5 vs 6.9; P = 0.008).…”

Section: Discussionmentioning

confidence: 99%

Nephrometry scores: a validation of three systems for peri‐operative outcomes in retroperitoneal robot‐assisted partial nephrectomy

et al. 2021

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Objective To externally validate the RENAL, PADUA and SPARE nephrometry scoring systems for use in retroperitoneal robot‐assisted partial nephrectomy (RAPN). Materials and Methods Nephrometry scores were calculated for 322 consecutive patients receiving retroperitoneal RAPN at a tertiary referral centre from 2017. Patients with multiple tumours were excluded. Scores were correlated with peri‐operative outcomes, including the trifecta (warm ischaemia time <25 min, no peri‐operative complications and a negative surgical margin), both as continuous and categorical variables. Comparisons were performed using Spearman correlation and ability to predict the trifecta was assessed using binomial logistical regression. Results All three scoring systems correlated significantly with the main variables (operating time, warm ischaemia time and estimated blood loss), both as continuous and categorical variables. Only PADUA and SPARE were able to predict achievement of the trifecta (PADUA area under the curve [AUC] 0.623, 95% confidence interval [CI] 0.559–0.668; SPARE AUC 0.612, 95% CI 0.548–0.677). Conclusion This study validates the RENAL, PADUA and SPARE scoring systems to predict key intra‐operative outcomes in retroperitoneal RAPN. Only PADUA and SPARE were able to predict achievement of the trifecta. As a simplified version of the PADUA scoring system with comparable outcomes, we recommend using the SPARE system.

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Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group

Cited by 26 publications

References 28 publications

Is partial nephrectomy safe and effective in the setting of frail comorbid patients affected by renal cell carcinoma? Insights from the RECORD 2 multicentre prospective study

Is partial nephrectomy safe and effective in the setting of frail comorbid patients affected by renal cell carcinoma? Insights from the RECORD 2 multicentre prospective study

Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses

Nephrometry scores: a validation of three systems for peri‐operative outcomes in retroperitoneal robot‐assisted partial nephrectomy

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