Comparative Analysis of Renal Functional Outcomes and Overall Survival of Elderly vs Nonelderly Patients Undergoing Radical Nephrectomy.

PURPOSE: To evaluate changes in renal function and overall survival in elderly vs nonelderly patients undergoing radical nephrectomy (RN) for renal masses. PATIENTS AND METHODS: We reviewed available records of 392 patients undergoing RN from 2008 through 2013. Patients were divided into elderly, defined as ≥70 years old (n = 110), or nonelderly (n = 282) at the time of nephrectomy. The groups were compared for perioperative characteristics, renal functional outcomes, and overall survival. Standard Student's t-tests were used for continuous variables and Fischer's exact tests for categorical comparisons. Kaplan-Meier estimate models for survival were compared using log-rank tests. RESULTS: Elderly patients were more likely to have comorbidities. Preoperative estimated glomerular filtration rate (GFR) of elderly patients was significantly lower (65.6 vs 77.9 mL/minute/1.73 m2, p = 0.0002), as was GFR at discharge (47.7 vs 57.2 mL/minute/1.73 m2, p = 0.001) and at maximum follow-up (46.8 vs 57.4 mL/minute/1.73 m2, p = 0.001). Of the patients with GFR >60 before surgery, de novo CKD stage III progression (defined as GFR <60) was detected in 74% of elderly and 53% nonelderly (odds ratio 2.47; 95% confidence interval 1.25-4.88; p = 0.01). Overall survival was not statistically different. When stratified for elderly and preoperative GFR <60, overall survival curves were not statistical different (log-rank test, p = 0.23). CONCLUSIONS: Elderly patients who undergo RN have worse renal functional outcomes. Following nephrectomy, these patients are at higher risk of CKD progression than nonelderly patients. However, there does not appear to be a difference in overall survival between cohorts, even when stratified for preoperative GFR <60. These findings should be considered during preoperative decision-making.

Duke Scholars

Author Michael B Rothberg Urology