Open Access

ARTICLE

Safety and outcomes of surgical treatment of renal cell carcinoma in the elderly

Rebecca L. O’Malley¹, Matthew H. Hayn¹, Nicholas J. Hellenthal¹, Hyung L. Kim^1,2, Willie Underwood III¹, Thomas Schwaab¹

1 Department of Urology, Roswell Park Cancer Institute, Buffalo, New York, USA
2 Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
Address correspondence to Dr. Rebecca L. O’Malley, Department of Urology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, New York 14263 USA

Canadian Journal of Urology 2012, 19(1), 6111-6117.

Abstract

Introduction: Treatment of the elderly patient with a small renal mass is becoming a common conundrum, with scant data available to support treatment decisions. The goal was to assess the risk of surgical treatment for renal cell carcinoma (RCC) in the elderly compared to their younger counterparts.
Materials and methods: A prospectively maintained database of all renal tumors between August 2004 and November 2009 was used. Patients who underwent extirpative treatment for RCC were divided into two groups based on age: < 75 years and ≥ 75 years. Primary outcome measures included the likelihood of undergoing partial nephrectomy versus radical nephrectomy, complication rates, and overall and cancer-specific survival. A secondary outcome investigated was postoperative renal function.
Results: Of 347 patients identified, 273 were < 75 years old and 74 were ≥ 75 years old. The elderly group was less likely to undergo partial nephrectomy (26% vs. 43%, p = 0.045). They also had a higher rate of pT3 disease (20% vs. 11%, p = 0.018), worse baseline renal function (46 mL/min/m² vs. 92 mL/min/m², p < 0.001), and longer length of stay (3.5 days vs. 2.2 days, p < 0.001). Complication rates, as well as overall and cancer-specific survival, were similar between the groups. Only ECOG score ≥ 1 and Charlson index ≥ 2 predicted an increased likelihood of experiencing a complication.
Conclusions: Despite a longer length of stay, renal surgery is safe in selected elderly patients with minimal comorbidity and good functional status. The elderly have reduced baseline renal function, indicating that nephron-sparing surgery should be chosen whenever possible when surgical intervention is elected.

---

Keywords

---