Postoperative outcomes of elderly patients undergoing partial nephrectomy

Alexandre Ingels (1) , Sophie Duc (2) , Karim Bensalah (3) , Pierre Bigot (4) , Philippe Paparel (5) , Jean-Baptiste Beauval (6) , Laurent Salomon (7) , Alexandre de La Taille (1) , Hervé Lang (8) , François-Xavier Nouhaud (9) , José Batista da Costa (1) , Charles Dariane (10) , Hervé Baumert (11) , Morgan Roupret (12) , Thibaut Waeckel (13) , Cédric Lebacle (14) , Jean-Alexandre Long (15) , François Henon (16) , Jean-Jacques Patard (7) , Nicolas Doumerc (17) , Arnaud Mejean (11) , Marie-Neige Videau (2) , Jean-Christophe Bernhard (2)

1 CHU Henri Mondor [Créteil]
2 CHU Bordeaux
3 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
4 CHU Angers - Centre Hospitalier Universitaire d'Angers
5 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
6 Clinique La Croix du Sud
7 CHU Mont de Marsan
8 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
9 CHU Rouen
10 HEGP - Hôpital Européen Georges Pompidou [APHP]
11 Centre hospitalier Saint-Joseph [Paris]
12 CHU Pitié-Salpêtrière [AP-HP]
13 CHU Caen
14 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
15 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
16 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
17 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse

To describe clinical outcomes of patients aged 75 years and above after partial nephrectomy (PN), and to assess independent factors of postoperative complications. We retrospectively reviewed information from our multi-institutional database. Every patient over 75 years old who underwent a PN between 2003 and 2016 was included. Peri-operative and follow up data were collected. Multivariate logistic regression was performed to determine independent predictive factors of postoperative complications. We reviewed 191 procedures including 69 (40%) open-surgery, and 122 (60%) laparoscopic procedures, of which 105 were robot-assisted. Median follow-up was 25 months. The mean age was 78 [75–88]. The American Society of Anesthesiologist’s score was 1, 2, 3 and 4 in 10.5%, 60%, 29% and 0.5% of patients respectively. The mean tumor size was 4.6 cm. Indication of PN was elective in 122 (65%) patients and imperative in 52 patients (28%). The median length of surgery was 150(± 60) minutes, and the median estimated blood loss 200 ml. The mean glomerular filtration rate was 71.5 ml/minute preoperatively, and 62 ml/min three months after surgery. The severe complications (Clavien III-V) rate was 6.2%. On multivariate analysis, the robotic-assisted procedure was an independent protective factor of medical postoperative complications (Odds Ration (OR) = 0.31 [0.12–0.80], p = 0.01). It was adjusted for age and RENAL score, robotic-assisted surgery (OR = 0.22 [0.06–0.79], p = 0.02), and tumor size (OR = 1.13 [1.02–1.26], p = 0.01), but the patients age did not forecast surgical complications. Partial nephrectomy can be performed safely in elderly patients with an acceptable morbidity, and should be considered as a viable treatment option. Robotic assistance is an independent protective factor of postoperative complications.

Mots clés: Cancer; Renal cancer

Domaines: Médecine humaine et pathologie

Alexandre Ingels, Sophie Duc, Karim Bensalah, Pierre Bigot, Philippe Paparel, et al.. Postoperative outcomes of elderly patients undergoing partial nephrectomy. Scientific Reports, 2021, 11 (1), ⟨10.1038/s41598-021-96676-y⟩. ⟨hal-03353840⟩