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Whiting D, Challacombe B, Madaan S, Fowler S, Napier-Hemy R, Sriprasad S. Complications after radical nephrectomy according to age: analysis from the British Association of Urological Surgeons Nephrectomy Audit. J Endourol 2021; 36:188-196. [PMID: 34663080 DOI: 10.1089/end.2021.0165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction To compare complication rates in radical nephrectomy for renal cell carcinoma across different age groups. Methods Retrospective analysis of the British Association of Urological Surgeons Nephrectomy Audit database between 1st January 2012 and 31st December 2017 was performed. Comparisons were made between different age groups (<60, 60-79, ≥80) in patients undergoing radical nephrectomy for renal cell carcinoma. Results 18438 patients with renal cell carcinoma underwent radical nephrectomy: 6128 (33.2%) aged <60, 10785 (58.5%) aged 60-79 and 1525 (8.3%) aged ≥80. There was a significantly lower pre-operative haemoglobin and eGFR with advancing age (p<0.001). Patients ≥80 had a higher Charlson co-morbidity index and WHO performance status (p<0.001). There was also significant variability in the approach to RN (p<0.001): laparoscopy was most commonly performed (68.8% vs. 69.3% vs. 75.0%). Patients ≥80 years were found to have the shortest operating time (p<0.001). There were significant differences in T stage between groups with patients aged ≥80 having a higher T stage (p<0.001). The incidence of intra-operative complications did not significantly differ between age groups (p=0.18). The incidence of post-operative complications was 15.7%, 18.2% and 20.5% and major post-operative complications was 1.4%, 2.1% and 2.8% in patients <60, 60-79 and ≥80, respectively (p<0.001). The most common complication in all age groups was blood transfusion (7.6% <60, 8.6% 60-79, 9.1% ≥80). Stepwise logistic regression analysis adjusting for additional variables found the odds of a post-operative complication increased with age with an odds ratio of 1.25 in patients ≥80 and an odds ratio of 1.09 in patients aged 60-70 compared with <60. Conclusion Overall complications in all age groups are low but advancing age should be considered as an independent risk factor for post-operative complications after radical nephrectomy and should be appropriately considered when counselling elderly patients prior to treatment.
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Affiliation(s)
- Danielle Whiting
- Darent Valley Hospital, 156489, Darent Valley Hospital, Darenth Wood Road, Dartford, United Kingdom of Great Britain and Northern Ireland, DA2 8DA;
| | - Benjamin Challacombe
- Guy's Hospital, Urology, London, London, United Kingdom of Great Britain and Northern Ireland, SE1 7RT;
| | - Sanjeev Madaan
- Darent Valley Hospital, 156489, Dartford, United Kingdom of Great Britain and Northern Ireland;
| | - Sarah Fowler
- British Association of Urological Surgeons, London, United Kingdom of Great Britain and Northern Ireland;
| | - Richard Napier-Hemy
- Manchester University NHS Foundation Trust, 5293, Manchester, Greater Manchester, United Kingdom of Great Britain and Northern Ireland;
| | - Seshadri Sriprasad
- Darent Valley Hospital, 156489, Dartford, United Kingdom of Great Britain and Northern Ireland;
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O'Sullivan M, Kearney DE, Giri SK, Coffey JC. Combined laparoscopic-assisted nephrectomy and complete mesocolic excision for synchronous renal and colon cancers. BMJ Case Rep 2015; 2015:bcr-2015-211681. [PMID: 26420697 DOI: 10.1136/bcr-2015-211681] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Cancers of the colon and kidney are common malignancies, however, the occurrence of primary synchronous neoplasms of these two organs is uncommon. To the best of our knowledge, this is the first case report of a laparoscopic radical left nephrectomy and extended right complete mesocolic excision (CME) for a patient with synchronous renal and colon cancers. While a radical nephrectomy has long been the standard of care for a renal malignancy, CME has only recently been used. Combined surgeries provide the patient with various benefits such as decreased hospital stay, less postoperative pain and morbidity, early return to work and better cosmoses.
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Affiliation(s)
- M O'Sullivan
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - D E Kearney
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - S K Giri
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - J C Coffey
- Department of Surgery, University Hospital Limerick, Limerick, Ireland Department of Centre for Interventions in Infection, Inflammation and Immunity, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Miller AJ, Kurup AN, Schmit GD, Weisbrod AJ, Boorjian SA, Thompson RH, Lohse CM, Kor DJ, Callstrom MR, Atwell TD. Percutaneous Clinical T1a Renal Mass Ablation in the Octogenarian and Nonagenarian: Oncologic Outcomes and Morbidity. J Endourol 2015; 29:671-6. [DOI: 10.1089/end.2014.0733] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Christine M. Lohse
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Darryl J. Kor
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
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Comparison of diameter-axial-polar nephrometry and RENAL nephrometry score for treatment decision-making in patients with small renal mass. Int J Clin Oncol 2014; 20:358-61. [DOI: 10.1007/s10147-014-0714-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/26/2014] [Indexed: 01/20/2023]
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Ghoneim IA, Fergany AF. Minimally invasive surgery for renal cell carcinoma. Expert Rev Anticancer Ther 2014; 9:989-97. [DOI: 10.1586/era.09.59] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Permpongkosol S. Urologic Laparoscopic Surgeries in Elderly: Analysis of Pre-Operative Risk Factors and Postoperative Complications. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/oju.2013.35036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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9
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[Coping with small renal tumors in the elderly]. Urologe A 2012; 51:1381-5. [PMID: 23053033 DOI: 10.1007/s00120-012-2921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
With the continually increasing number of elderly patients and the widely distributed use of radiological imaging techniques, the number of elderly patients with incidentally discovered asymptomatic small renal tumors will increase further. Treatment options range from active surveillance, minimally invasive (ablative) techniques, to open or laparoscopic surgery including radical nephrectomy. Many studies have been published on the operative treatment of small renal tumors in the elderly; however, all are limited by the retrospective nature and the small number of cases. Chronological age per se should not be a deciding factor or even an exclusion criterion for treatment of small renal tumors. The decision for therapy should be based on the physical state (comorbidities), mental and emotional state of the patient as well as the individual psychosocial environment. The decision for surgery should be based on organ preservation, depending on the tumor size of ˂7 cm and location, whenever possible.
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Berger J, Fardoun T, Brassart E, Capon G, Bigot P, Bernhard JC, Rigaud J, Patard JJ, Descazeaud A. Detailed Analysis of Morbidity Following Nephrectomy for Renal Cell Carcinoma in Octogenarians. J Urol 2012; 188:736-40. [DOI: 10.1016/j.juro.2012.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Julien Berger
- Department of Urology, Dupuytren University Hospital, Limoges, France
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Retroperitoneoscopic nephrectomy for non-functioning kidneys related to renal stone disease. ACTA ACUST UNITED AC 2012; 40:559-65. [PMID: 22331348 DOI: 10.1007/s00240-012-0466-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 01/27/2012] [Indexed: 10/28/2022]
Abstract
Laparoscopic nephrectomy has become the gold standard procedure for nonfunctioning or symptomatic benign kidneys due to renal calculi, obstructive, refluxive, and inflammatory nephropathies or renovascular hypertension. We aimed to investigate the effect of renal calculi as a reason of non-functioning on the progress and complication rates of the retroperitoneoscopic nephrectomy (RPN). During a 2-year period, 108 patients with benign renal conditions underwent RPN by single surgeon. Among these patients, total of 27 (Group 1) with a non-functioning kidney due to renal calculi were retrospectively compared with 27 patients (Group 2) with other benign renal conditions. The two groups were matched for age, body mass index, and previous renal surgery. We analyzed operative and post-operative findings and complications. The mean age and the BMI of the groups were similar. The operation time was significantly longer in Group 1 than Group 2 (p = 0.0001). There was no significant difference between the groups with respect to mean hemoglobin drop postoperatively (p = 0.9) and hospitalization time (p = 0.06). The perioperative and postoperative complication rates were higher in Group 1 but not statistically different from Group 2 (p = 0.19, p = 0.29, respectively). RPN for nonfunctioning calculous kidneys is more challenging procedure and is associated with prolonged operation time related to difficult dissection of dense adhesions. It can be safely performed by experienced hands with similar perioperative and postoperative complication rates as well as for other benign conditions of the kidney.
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Kidney cancer: treatment of clinically localized renal tumors in the elderly. Nat Rev Urol 2011; 8:595-6. [PMID: 21989303 DOI: 10.1038/nrurol.2011.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Roos FC, Thomas C, Hampel C, Thüroff JW. Nephron-sparing surgery versus radical nephrectomy for kidney tumors: benefits and limitations. Expert Rev Anticancer Ther 2011; 11:805-8. [PMID: 21707272 DOI: 10.1586/era.11.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Deklaj T, Lifshitz DA, Shikanov SA, Kiriluk K, Katz MH, Shalhav AL, Zorn KC. Localized T1a Renal Lesions in the Elderly: Outcomes of Laparoscopic Renal Surgery. J Endourol 2010; 24:397-401. [DOI: 10.1089/end.2009.0195] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tom Deklaj
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - David A. Lifshitz
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Sergey A. Shikanov
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Kyle Kiriluk
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Mark H. Katz
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Arieh L. Shalhav
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Kevin C. Zorn
- Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
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Abouassaly R, Alibhai SM, Tomlinson G, Timilshina N, Finelli A. Unintended Consequences of Laparoscopic Surgery on Partial Nephrectomy for Kidney Cancer. J Urol 2010; 183:467-72. [DOI: 10.1016/j.juro.2009.10.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Robert Abouassaly
- Division of Urologic Oncology, Princess Margaret Hospital and Department of Health Policy, Management and Evaluation (SMHA, GT, NT), University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M.H. Alibhai
- Division of Urologic Oncology, Princess Margaret Hospital and Department of Health Policy, Management and Evaluation (SMHA, GT, NT), University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- Division of Urologic Oncology, Princess Margaret Hospital and Department of Health Policy, Management and Evaluation (SMHA, GT, NT), University of Toronto, Toronto, Ontario, Canada
| | - Narhari Timilshina
- Division of Urologic Oncology, Princess Margaret Hospital and Department of Health Policy, Management and Evaluation (SMHA, GT, NT), University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urologic Oncology, Princess Margaret Hospital and Department of Health Policy, Management and Evaluation (SMHA, GT, NT), University of Toronto, Toronto, Ontario, Canada
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Thornton RH, Covey A, Petre EN, Riedel ER, Maluccio MA, Sofocleous CT, Brody LA, Getrajdman GI, D'Angelica M, Fong Y, Brown KT. A comparison of outcomes from treating hepatocellular carcinoma by hepatic artery embolization in patients younger or older than 70 years. Cancer 2009; 115:5000-6. [PMID: 19642175 DOI: 10.1002/cncr.24556] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND : The objective of this study was to compare the morbidity, mortality, and survival of patients aged <70 years and aged > or =70 years who underwent hepatic arterial embolization (HAE) for the treatment of hepatocellular carcinoma (HCC). METHODS : Between 1997 and 2007, 386 patients underwent HAE for HCC at a single center. Two hundred patients were aged <70 years (153 men; median age, 60 years), and 186 patients were aged > or =70 years (128 men; median age, 75 years). Patients underwent a total 965 embolization procedures (median, 2 procedures per patient). Patient demographics, morbidity, mortality, length of hospital stay, and survival were analyzed. Complications were categorized using Common Terminology Criteria for Adverse Events, version 3.0 guidelines. Survival was calculated by using the Kaplan-Meier method. RESULTS : There were no significant differences between younger and older groups in the incidence of infectious, hepatobiliary, renal, vascular, or miscellaneous complications (P > or = .05); complication severity (P = .82); procedural mortality (P = .63); length of hospitalization (P = .55); intensive care unit admission (P = .64); or overall survival (P = .30). There were more cardiopulmonary complications in the older group (P = .04), but the association of age and likelihood of a cardiopulmonary complication lost significance after adjusting for the presence of more cardiovascular comorbidities in the older group (P = .08). CONCLUSIONS : Survival and mortality outcomes of HAE for the treatment of HCC were similar whether patients were aged <70 years or > or =70 years. Although patients aged > or =70 years with cardiovascular comorbidities more often had a cardiopulmonary complication, other morbidity measures, including complication severity, need for intensive care unit admission, and length of hospitalization, were similar between groups. Cancer 2009. (c) 2009 American Cancer Society.
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Affiliation(s)
- Raymond H Thornton
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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Schuckman AK, Stein JP, Skinner D. Surgical considerations for elderly urologic oncology patients. Urol Oncol 2009; 27:628-32. [PMID: 19879473 DOI: 10.1016/j.urolonc.2009.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In light of the aging population and the high incidence of urologic malignancies in the elderly in the United States, we review issues surrounding radical urologic surgery in the elderly. Specifically, we examine the safety, efficacy, techniques, and special concerns related to elderly patients. We found in multiple series that well selected, elderly patients can safely undergo major, extirpative urologic surgery with acceptable morbidity, comparable to their younger counterparts. Tools, such as the ASA score, Karnofsky index, and Charlson index may help guide patient selection and counseling.
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Affiliation(s)
- Anne K Schuckman
- Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA 90089, USA.
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Guzzo TJ, Allaf ME, Pierorazio PM, Miller D, McNeil BK, Kavoussi LR, Pavlovich CP, Schaeffer EM. Perioperative Outcomes of Elderly Patients Undergoing Laparoscopic Renal Procedures. Urology 2009; 73:572-6. [DOI: 10.1016/j.urology.2008.09.071] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Revised: 07/13/2008] [Accepted: 09/20/2008] [Indexed: 11/27/2022]
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Lee SH, Yoo KH, Min GE, Lee HL, Chang SG, Jeon SH. The Factors Affecting Non-Urologic Postoperative Complications after Laparoscopic Surgery in the Urologic Area. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.8.780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sang Hyub Lee
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Koo Han Yoo
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Gyeong Eun Min
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyung Lae Lee
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sung-Goo Chang
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seung Hyun Jeon
- Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea
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