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Renal tumour surgery in elderly patients
Frederik C Roos1, Sascha Pahernik, Sebastian W Melchior
1Department of Urology, Johannes Gutenberg-University, Medical School, Mainz, Germany. frederik.roos@gmx.de
Objective:
To analyse morbidity, renal function and oncological outcome in patients aged >or=80 years who had surgery for renal tumours, as in the elderly such surgery is controversial in relation to life-expectancy and other causes of death.
Patients And Methods:
Between 1990 and 2006, in our institution 1625 patients had surgery to treat solid renal tumours suspected to be renal cell carcinoma (RCC); 62 (4%) were aged >or=80 years (mean 82.5), and 73% of these elderly patients had radical nephrectomy (RN) and 27% nephron-sparing surgery (NSS).
Results:
The median (range) follow-up was 3.1 (0.2-14.1) years (89% of the patients). There was no perioperative mortality. There were only minor complications in 47% of patients, most (34%) being temporary increases in serum creatinine level. Histopathologically, 10% of the 62 patients had benign lesions and 90% had RCC. Of the 56 patients with RCC, the stage was pT1a in 34%, pT1b in 25%, pT2 in 5% and pT3 in 36%. For those treated with RN the median (range) serum creatinine level before and after RN was 1.0 (0.7-1.8) and 1.4 (1.0-2.8) mg/dL (P < 0.05), and for those treated with NSS were 1.1 (0.7-4.4) and 1.2 (0.7-4.8) mg/dL (not significant), respectively. The 5-year overall survival was 68% and the cancer-specific survival was 85%.
Conclusions:
Surgery for renal tumours is safe in elderly patients, with a low perioperative morbidity and a good overall survival rate. Patients should be selected carefully according to comorbidities, biological age and social support.