Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge)

Alessandro Antonelli, Alessandro Veccia, Nicola Pavan, Carmen Mir, Alberto Breda, Toshio Takagi, Koon H. Rha, Tobias Maurer, Chao Zhang, Jean Alexandre Long, Cosimo De Nunzio, Estevão Lima, Matteo Ferro, Salvatore Micali, Giuseppe Quarto, Estefania Linares, Antonio Celia, Luigi Schips, Pierluigi Bove, Alessandro LarcherCristian Fiori, Alexandre Mottrie, Ahmet Bindayi, Carlo Trombetta, Tommaso Silvestri, Joan Palou, Oscar Rodriguez Faba, Kazunari Tanabe, Bo Yang, Gaelle Fiard, Andrea Tubaro, Joao Nuno Torres, Ottavio De Cobelli, Luigi Bevilacqua, Roberto Castellucci, Andrew Tracey, Lance J. Hampton, Francesco Montorsi, Sisto Perdonà, Claudio Simeone, Carlotta Palumbo, Umberto Capitanio, Ithaar Derweesh, Francesco Porpiglia, Riccardo Autorino

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: To analyze the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in octogenarian patients. METHODS: The RESURGE (REnal SUrgery in the Eldely) multi-institutional database was queried to identify patients ≥80 years old who had undergone a PN or RN for a renal tumor. Multivariable binary logistic regression estimated the association between type of surgery and occurrence of complications. Multivariable Cox regression model assessed the association between type of surgery and All-Causes Mortality. RESULTS: The study analyzed 585 patients (median age 83 years, IQR 81-84), 364 of whom (62.2%) underwent RN and 221 (37.8%) PN. Patients undergoing RN were older (P = .0084), had larger tumor size (P < .0001) and higher clinical stage (P < .001). At multivariable analysis for complications, the only significant difference was found for lower risk of major postoperative complications for laparoscopic RN compared to open RN (OR: 0.42; P = .04). The rate of significant (>25%) decrease of eGFR in PN and RN was 18% versus 59% at 1 month, and 23% versus 65% at 6 months (P < .0001). After a median follow-up time of 39 months, 161 patients (31%) died, of whom 105 (20%) due to renal cancer. CONCLUSION: In this patient population both RN and PN carry a non-negligible risk of complications. When surgical removal is indicated, PN should be preferred, whenever technically feasible, as it can offer better preservation of renal function, without increasing the risk of complications. Moreover, a minimally invasive approach should be pursued, as it can translate into lower surgical morbidity.

Original languageEnglish
Pages (from-to)139-145
Number of pages7
JournalUrology
Volume129
DOIs
Publication statusPublished - 2019 Jul

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Nephrectomy
Multicenter Studies
Kidney
Kidney Neoplasms
Proportional Hazards Models
Neoplasms
Logistic Models
Databases
Morbidity

All Science Journal Classification (ASJC) codes

  • Urology

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Antonelli, A., Veccia, A., Pavan, N., Mir, C., Breda, A., Takagi, T., ... Autorino, R. (2019). Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge). Urology, 129, 139-145. https://doi.org/10.1016/j.urology.2019.03.009
Antonelli, Alessandro ; Veccia, Alessandro ; Pavan, Nicola ; Mir, Carmen ; Breda, Alberto ; Takagi, Toshio ; Rha, Koon H. ; Maurer, Tobias ; Zhang, Chao ; Long, Jean Alexandre ; De Nunzio, Cosimo ; Lima, Estevão ; Ferro, Matteo ; Micali, Salvatore ; Quarto, Giuseppe ; Linares, Estefania ; Celia, Antonio ; Schips, Luigi ; Bove, Pierluigi ; Larcher, Alessandro ; Fiori, Cristian ; Mottrie, Alexandre ; Bindayi, Ahmet ; Trombetta, Carlo ; Silvestri, Tommaso ; Palou, Joan ; Faba, Oscar Rodriguez ; Tanabe, Kazunari ; Yang, Bo ; Fiard, Gaelle ; Tubaro, Andrea ; Torres, Joao Nuno ; De Cobelli, Ottavio ; Bevilacqua, Luigi ; Castellucci, Roberto ; Tracey, Andrew ; Hampton, Lance J. ; Montorsi, Francesco ; Perdonà, Sisto ; Simeone, Claudio ; Palumbo, Carlotta ; Capitanio, Umberto ; Derweesh, Ithaar ; Porpiglia, Francesco ; Autorino, Riccardo. / Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge). In: Urology. 2019 ; Vol. 129. pp. 139-145.
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abstract = "OBJECTIVE: To analyze the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in octogenarian patients. METHODS: The RESURGE (REnal SUrgery in the Eldely) multi-institutional database was queried to identify patients ≥80 years old who had undergone a PN or RN for a renal tumor. Multivariable binary logistic regression estimated the association between type of surgery and occurrence of complications. Multivariable Cox regression model assessed the association between type of surgery and All-Causes Mortality. RESULTS: The study analyzed 585 patients (median age 83 years, IQR 81-84), 364 of whom (62.2{\%}) underwent RN and 221 (37.8{\%}) PN. Patients undergoing RN were older (P = .0084), had larger tumor size (P < .0001) and higher clinical stage (P < .001). At multivariable analysis for complications, the only significant difference was found for lower risk of major postoperative complications for laparoscopic RN compared to open RN (OR: 0.42; P = .04). The rate of significant (>25{\%}) decrease of eGFR in PN and RN was 18{\%} versus 59{\%} at 1 month, and 23{\%} versus 65{\%} at 6 months (P < .0001). After a median follow-up time of 39 months, 161 patients (31{\%}) died, of whom 105 (20{\%}) due to renal cancer. CONCLUSION: In this patient population both RN and PN carry a non-negligible risk of complications. When surgical removal is indicated, PN should be preferred, whenever technically feasible, as it can offer better preservation of renal function, without increasing the risk of complications. Moreover, a minimally invasive approach should be pursued, as it can translate into lower surgical morbidity.",
author = "Alessandro Antonelli and Alessandro Veccia and Nicola Pavan and Carmen Mir and Alberto Breda and Toshio Takagi and Rha, {Koon H.} and Tobias Maurer and Chao Zhang and Long, {Jean Alexandre} and {De Nunzio}, Cosimo and Estev{\~a}o Lima and Matteo Ferro and Salvatore Micali and Giuseppe Quarto and Estefania Linares and Antonio Celia and Luigi Schips and Pierluigi Bove and Alessandro Larcher and Cristian Fiori and Alexandre Mottrie and Ahmet Bindayi and Carlo Trombetta and Tommaso Silvestri and Joan Palou and Faba, {Oscar Rodriguez} and Kazunari Tanabe and Bo Yang and Gaelle Fiard and Andrea Tubaro and Torres, {Joao Nuno} and {De Cobelli}, Ottavio and Luigi Bevilacqua and Roberto Castellucci and Andrew Tracey and Hampton, {Lance J.} and Francesco Montorsi and Sisto Perdon{\`a} and Claudio Simeone and Carlotta Palumbo and Umberto Capitanio and Ithaar Derweesh and Francesco Porpiglia and Riccardo Autorino",
year = "2019",
month = "7",
doi = "10.1016/j.urology.2019.03.009",
language = "English",
volume = "129",
pages = "139--145",
journal = "Urology",
issn = "0090-4295",
publisher = "Elsevier Inc.",

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Antonelli, A, Veccia, A, Pavan, N, Mir, C, Breda, A, Takagi, T, Rha, KH, Maurer, T, Zhang, C, Long, JA, De Nunzio, C, Lima, E, Ferro, M, Micali, S, Quarto, G, Linares, E, Celia, A, Schips, L, Bove, P, Larcher, A, Fiori, C, Mottrie, A, Bindayi, A, Trombetta, C, Silvestri, T, Palou, J, Faba, OR, Tanabe, K, Yang, B, Fiard, G, Tubaro, A, Torres, JN, De Cobelli, O, Bevilacqua, L, Castellucci, R, Tracey, A, Hampton, LJ, Montorsi, F, Perdonà, S, Simeone, C, Palumbo, C, Capitanio, U, Derweesh, I, Porpiglia, F & Autorino, R 2019, 'Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge)', Urology, vol. 129, pp. 139-145. https://doi.org/10.1016/j.urology.2019.03.009

Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge). / Antonelli, Alessandro; Veccia, Alessandro; Pavan, Nicola; Mir, Carmen; Breda, Alberto; Takagi, Toshio; Rha, Koon H.; Maurer, Tobias; Zhang, Chao; Long, Jean Alexandre; De Nunzio, Cosimo; Lima, Estevão; Ferro, Matteo; Micali, Salvatore; Quarto, Giuseppe; Linares, Estefania; Celia, Antonio; Schips, Luigi; Bove, Pierluigi; Larcher, Alessandro; Fiori, Cristian; Mottrie, Alexandre; Bindayi, Ahmet; Trombetta, Carlo; Silvestri, Tommaso; Palou, Joan; Faba, Oscar Rodriguez; Tanabe, Kazunari; Yang, Bo; Fiard, Gaelle; Tubaro, Andrea; Torres, Joao Nuno; De Cobelli, Ottavio; Bevilacqua, Luigi; Castellucci, Roberto; Tracey, Andrew; Hampton, Lance J.; Montorsi, Francesco; Perdonà, Sisto; Simeone, Claudio; Palumbo, Carlotta; Capitanio, Umberto; Derweesh, Ithaar; Porpiglia, Francesco; Autorino, Riccardo.

In: Urology, Vol. 129, 07.2019, p. 139-145.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge)

AU - Antonelli, Alessandro

AU - Veccia, Alessandro

AU - Pavan, Nicola

AU - Mir, Carmen

AU - Breda, Alberto

AU - Takagi, Toshio

AU - Rha, Koon H.

AU - Maurer, Tobias

AU - Zhang, Chao

AU - Long, Jean Alexandre

AU - De Nunzio, Cosimo

AU - Lima, Estevão

AU - Ferro, Matteo

AU - Micali, Salvatore

AU - Quarto, Giuseppe

AU - Linares, Estefania

AU - Celia, Antonio

AU - Schips, Luigi

AU - Bove, Pierluigi

AU - Larcher, Alessandro

AU - Fiori, Cristian

AU - Mottrie, Alexandre

AU - Bindayi, Ahmet

AU - Trombetta, Carlo

AU - Silvestri, Tommaso

AU - Palou, Joan

AU - Faba, Oscar Rodriguez

AU - Tanabe, Kazunari

AU - Yang, Bo

AU - Fiard, Gaelle

AU - Tubaro, Andrea

AU - Torres, Joao Nuno

AU - De Cobelli, Ottavio

AU - Bevilacqua, Luigi

AU - Castellucci, Roberto

AU - Tracey, Andrew

AU - Hampton, Lance J.

AU - Montorsi, Francesco

AU - Perdonà, Sisto

AU - Simeone, Claudio

AU - Palumbo, Carlotta

AU - Capitanio, Umberto

AU - Derweesh, Ithaar

AU - Porpiglia, Francesco

AU - Autorino, Riccardo

PY - 2019/7

Y1 - 2019/7

N2 - OBJECTIVE: To analyze the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in octogenarian patients. METHODS: The RESURGE (REnal SUrgery in the Eldely) multi-institutional database was queried to identify patients ≥80 years old who had undergone a PN or RN for a renal tumor. Multivariable binary logistic regression estimated the association between type of surgery and occurrence of complications. Multivariable Cox regression model assessed the association between type of surgery and All-Causes Mortality. RESULTS: The study analyzed 585 patients (median age 83 years, IQR 81-84), 364 of whom (62.2%) underwent RN and 221 (37.8%) PN. Patients undergoing RN were older (P = .0084), had larger tumor size (P < .0001) and higher clinical stage (P < .001). At multivariable analysis for complications, the only significant difference was found for lower risk of major postoperative complications for laparoscopic RN compared to open RN (OR: 0.42; P = .04). The rate of significant (>25%) decrease of eGFR in PN and RN was 18% versus 59% at 1 month, and 23% versus 65% at 6 months (P < .0001). After a median follow-up time of 39 months, 161 patients (31%) died, of whom 105 (20%) due to renal cancer. CONCLUSION: In this patient population both RN and PN carry a non-negligible risk of complications. When surgical removal is indicated, PN should be preferred, whenever technically feasible, as it can offer better preservation of renal function, without increasing the risk of complications. Moreover, a minimally invasive approach should be pursued, as it can translate into lower surgical morbidity.

AB - OBJECTIVE: To analyze the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in octogenarian patients. METHODS: The RESURGE (REnal SUrgery in the Eldely) multi-institutional database was queried to identify patients ≥80 years old who had undergone a PN or RN for a renal tumor. Multivariable binary logistic regression estimated the association between type of surgery and occurrence of complications. Multivariable Cox regression model assessed the association between type of surgery and All-Causes Mortality. RESULTS: The study analyzed 585 patients (median age 83 years, IQR 81-84), 364 of whom (62.2%) underwent RN and 221 (37.8%) PN. Patients undergoing RN were older (P = .0084), had larger tumor size (P < .0001) and higher clinical stage (P < .001). At multivariable analysis for complications, the only significant difference was found for lower risk of major postoperative complications for laparoscopic RN compared to open RN (OR: 0.42; P = .04). The rate of significant (>25%) decrease of eGFR in PN and RN was 18% versus 59% at 1 month, and 23% versus 65% at 6 months (P < .0001). After a median follow-up time of 39 months, 161 patients (31%) died, of whom 105 (20%) due to renal cancer. CONCLUSION: In this patient population both RN and PN carry a non-negligible risk of complications. When surgical removal is indicated, PN should be preferred, whenever technically feasible, as it can offer better preservation of renal function, without increasing the risk of complications. Moreover, a minimally invasive approach should be pursued, as it can translate into lower surgical morbidity.

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DO - 10.1016/j.urology.2019.03.009

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