The aim of the study was to perform a comprehensive investigation of clinical outcomes of robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in elderly patients presenting with a renal mass. The REnal SURGery in Elderly (RESURGE) collaborative database was queried to identify patients aged 75 or older diagnosed with cT1-2 renal mass and treated with RAPN or LPN. Study outcomes were: overall complications (OC); warm ischemia time (WIT) and 6-month estimated glomerular filtration rate (eGFR); positive surgical margins (PSM), disease recurrence (REC), cancer-specific mortality (CSM) and other-cause mortality (OCM). Descriptive statistics, Kaplan-Meier, smoothed Poisson plots and logistic and linear regression models (MVA) were used. Overall, 216 patients were included in this analysis. OC rate was 34%, most of them being of low Clavien grade. Median WIT was 17 minutes and median 6-month eGFR was 54 ml/min/1.73 m2. PSM rate was 5%. After a median follow-up of 20 months, the 5-year rates of REC, CSM and OCM were 4, 4 and 5%, respectively. At MVA predicting perioperative morbidity, RAPN relative to LPN (odds ratio [OR] 0.33; p <0.0001) was associated with lower OC rate. At MVA predicting functional outcomes, RAPN relative to LPN was associated with shorter WIT (estimate [EST]-4.09; p <0.0001), and with higher 6-month eGFR (EST 6.03; p = 0.01). In appropriately selected patients with small renal masses, minimally-invasive PN is associated with acceptable perioperative outcomes. The use of a robotic approach over a standard laparoscopic approach can be advantageous with respect to clinically relevant outcomes, and it should be preferred when available.
Outcomes of minimally invasive partial nephrectomy among very elderly patients: Report from the resurge collaborative international database / Larcher, A.; Wallis, C. J. D.; Pavan, N.; Porpiglia, F.; Takagi, T.; Tanabe, K.; Rha, K. H.; Raheem, A. A.; Yang, B.; Zang, C.; Perdona, S.; Quarto, G.; Maurer, T.; Amiel, T.; Schips, L.; Castellucci, R.; Crivellaro, S.; Dobbs, R.; Baiamonte, G.; Celia, A.; De Concilio, B.; Furlan, M.; Lima, E.; Linares, E.; Micali, S.; Amparore, D.; De Naeyer, G.; Trombetta, C.; Hampton, L. J.; Tracey, A.; Bindayi, A.; Antonelli, A.; Derweesh, I.; Mir, C.; Montorsi, F.; Mottrie, A.; Autorino, R.; Capitanio, U.. - In: CENTRAL EUROPEAN JOURNAL OF UROLOGY. - ISSN 2080-4806. - 73:3(2020), pp. 273-279. [10.5173/ceju.2020.0179]