Presented by: Jennifer L Nguyen B.S.
Department of Urology, Hackensack University Medical Center

Introduction

We aim to evaluate the utilization of partial nephrectomy (PN) and radical nephrectomy (RN) among 3 different age groups and compare outcomes for patients ≥75 years. 

Materials

We utilized a prospectively maintained multi-institutional database of patients that underwent PN or RN between 2002 and 2023. Baseline characteristics, perioperative, and postoperative outcomes were compared between  ≤59, 60-74, and ≥75 years of age.  Logistic regression was used to examine associations between baseline characteristics and receipt of PN.

Results

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Of 4,035 patients, 3,464 (85.85%) underwent PN and 571 (14.15%) RN. Patients ≥75yr had higher comorbidity index, proportion of patients with hypertension and diabetes, and lower baseline eGFR.  However, they have decreased utilization of PN (80.48%, p<0.001). Compared to patients >75yrs who had PN, those who received RN had larger tumor size (5.5 vs. 3.1cm, p<0.001), R.E.N.A.L. score (10 vs. 7, p<0.001), and tumor complexity (p<0.001). Conversely, for those who received PN, there was no increase in surgical margins or complication rates, but a significant benefit in terms of ∆GFR (-5.73 vs. -18.86, RN; p<0.001). In adjusted analysis, high tumor complexity and increased tumor size were associated with decreased odds of receiving PN in all cohorts.

Conclusion

There is decreased utilization of PN among the elderly (≥75yr) despite the need for PN given their comorbid indications that affect kidney function. PN is safe and feasible for select elderly patients with a smaller decrease in eGFR. Therefore, elderly patients may potentially benefit from PN. In patients ≥75yr receiving a RN, 22% met elective criteria for PN suggesting potential for age bias.  Advanced age alone should not deter the use of PN in appropriately selected patients.

Funding

No funding was received for this article.

Co-Authors

Kennedy Okhawere,
Department of Urology, Mount Sinai Health System

Teona Iarajuli, MD
Hackensack University Medical Center

Fahad Sheckley, MD
Department of Urology, Hackensack University Medical Center

Catherine Implicito,
Hackensack Meridian School of Medicine

Hunter Hasley,
Hackensack Meridian School of Medicine

Laura Zuluaga,
Department of Urology, Mount Sinai Health System

Indu Saini,
Department of Urology, Mount Sinai Health System

Kevin Basralian, MD
Department of Urology, Hackensack University Medical Center

Sharon Seidman,
Department of Urology, Hackensack University Medical Center

Mutahar Ahmed, MD
Department of Urology, Hackensack University Medical Center

Ahmed Mansour, MD
Department of Urology, UT Health San Antonio

Ronney Abaza, MD
Ohio Health

Daniel D Eun, MD
Department of Urology, Temple University Hospital

Akshay Bhandari, MD
Division of Urology, Mount Sinai Medical Center

Ashok Hemal, MD
Department of Urology, Atrium Health Wake Forest Baptist & Wake Forest School of Medicine

James Porter, MD
Swedish Medical Center

Ravi Munver, MD
Department of Urology, Hackensack University Medical Center

Simone Crivellaro, MD
Department of Urology, University of Illinois at Chicago

Ketan Badani, MD
Department of Urology, Mount Sinai Health System

Michael Stifelman, MD
Department of Urology, Hackensack University Medical Center