Treating renal cell cancer in the elderly

Area of Science:

• Urology
• Surgical Oncology
• Geriatric Surgery

Background:

• Renal cell carcinoma (RCC) surgery in elderly patients (>75 years) presents unique challenges.
• Comorbidity and advanced age are often considered risk factors for surgical outcomes.

Purpose of the Study:

• To evaluate if patient age and comorbidity predict peri-operative complications and mortality in renal cell cancer surgery.
• To assess the impact of advanced age on surgical outcomes for renal cell carcinoma.

Main Methods:

• Retrospective analysis of 1153 patients undergoing radical nephrectomy or nephron-sparing surgery for RCC (1993-2003).
• Patients were stratified into two groups: aged ≥75 years (n=115) and <75 years (n=908).
• Preoperative American Society of Anesthesiologists (ASA) scores were used for risk stratification; peri-operative mortality and early complications (30-day) were reviewed.

Main Results:

• Older patients had significantly higher ASA scores, indicating greater comorbidity.
• Early complications occurred in 3.4% of younger patients versus 1.7% of older patients.
• Peri-operative mortality was higher in older patients (1.7%) compared to younger patients (0.3%), though not statistically significant (P=0.29). Overall morbidity and mortality correlated with increasing ASA score (P < 0.05) but not with age.

Conclusions:

• Despite higher comorbidity, older patients did not experience significantly different morbidity or mortality compared to younger patients undergoing renal cell cancer surgery.
• Advanced age alone should not be a contraindication for renal cell carcinoma surgery.
• Older patients should be informed about the potential for increased comorbidity-related peri-operative mortality.