Postoperative outcomes of elderly patients undergoing partial nephrectomy
Abstract To describe clinical outcomes of patients aged 75 years and above after partial nephrectomy (PN), and to assess independent factors of postoperative complications. We retrospectively reviewed information from our multi-institutional database. Every patient over 75 years old who underwent a...
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2021-08-01
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doaj-8d82c46895574699a1b40680f0a407f72021-08-29T11:24:54ZengNature Publishing GroupScientific Reports2045-23222021-08-011111810.1038/s41598-021-96676-yPostoperative outcomes of elderly patients undergoing partial nephrectomyAlexandre Ingels0Sophie Duc1Karim Bensalah2Pierre Bigot3Philippe Paparel4Jean-Baptiste Beauval5Laurent Salomon6Alexandre De La Taille7Hervé Lang8François-Xavier Nouhaud9José Batista Da Costa10Charles Dariane11Hervé Baumert12Morgan Roupret13Thibaut Waeckel14Cédric Lebacle15Jean-Alexandre Long16François Henon17Jean-Jacques Patard18Nicolas Doumerc19Arnaud Mejean20Marie-Neige Videau21Jean-Christophe Bernhard22Department of Urology, University Hospital Henri Mondor. APHP. UPEC. AP-HPDepartment of Geriatrics, Pôle de Gérontologie Clinique Xavier Arnozan, CHU BordeauxDepartment of Urology, University of RennesDepartment of Urology, Angers University HospitalDepartment of Urology, Lyon Sud-Pierre Bénite Teaching HospitalDepartment of Urology, Saint Jean Languedoc/La Croix du Sud HospitalDepartment of Urology, Hôpital Mont-de-MarsanDepartment of Urology, University Hospital Henri Mondor. APHP. UPEC. AP-HPDepartment of Urology, University Hospital of StrasbourgDepartment of Urology, Rouen University HospitalDepartment of Urology, University Hospital Henri Mondor. APHP. UPEC. AP-HPDepartment of Urology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges PompidouDepartment of Urology, Paris Saint-Joseph HospitalDepartment of Urology, Sorbonne University, APHP, Pitié-Salpêtrière HôpitalDepartment of Urology, Caen University HospitalDepartment of Urology, Hôpitaux Universitaires Paris-SudDepartment of Urology, Grenoble University HospitalDepartment of Urology, Lille UniversityDepartment of Urology, Hôpital Mont-de-MarsanDepartment of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University HospitalDepartment of Urology, Paris Saint-Joseph HospitalDepartment of Geriatrics, Pôle de Gérontologie Clinique Xavier Arnozan, CHU BordeauxDepartment of Urology, Hôpital Pellegrin, Bordeaux University HospitalAbstract To describe clinical outcomes of patients aged 75 years and above after partial nephrectomy (PN), and to assess independent factors of postoperative complications. We retrospectively reviewed information from our multi-institutional database. Every patient over 75 years old who underwent a PN between 2003 and 2016 was included. Peri-operative and follow up data were collected. Multivariate logistic regression was performed to determine independent predictive factors of postoperative complications. We reviewed 191 procedures including 69 (40%) open-surgery, and 122 (60%) laparoscopic procedures, of which 105 were robot-assisted. Median follow-up was 25 months. The mean age was 78 [75–88]. The American Society of Anesthesiologist’s score was 1, 2, 3 and 4 in 10.5%, 60%, 29% and 0.5% of patients respectively. The mean tumor size was 4.6 cm. Indication of PN was elective in 122 (65%) patients and imperative in 52 patients (28%). The median length of surgery was 150(± 60) minutes, and the median estimated blood loss 200 ml. The mean glomerular filtration rate was 71.5 ml/minute preoperatively, and 62 ml/min three months after surgery. The severe complications (Clavien III-V) rate was 6.2%. On multivariate analysis, the robotic-assisted procedure was an independent protective factor of medical postoperative complications (Odds Ration (OR) = 0.31 [0.12–0.80], p = 0.01). It was adjusted for age and RENAL score, robotic-assisted surgery (OR = 0.22 [0.06–0.79], p = 0.02), and tumor size (OR = 1.13 [1.02–1.26], p = 0.01), but the patients age did not forecast surgical complications. Partial nephrectomy can be performed safely in elderly patients with an acceptable morbidity, and should be considered as a viable treatment option. Robotic assistance is an independent protective factor of postoperative complications.https://doi.org/10.1038/s41598-021-96676-y |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Alexandre Ingels Sophie Duc Karim Bensalah Pierre Bigot Philippe Paparel Jean-Baptiste Beauval Laurent Salomon Alexandre De La Taille Hervé Lang François-Xavier Nouhaud José Batista Da Costa Charles Dariane Hervé Baumert Morgan Roupret Thibaut Waeckel Cédric Lebacle Jean-Alexandre Long François Henon Jean-Jacques Patard Nicolas Doumerc Arnaud Mejean Marie-Neige Videau Jean-Christophe Bernhard |
spellingShingle |
Alexandre Ingels Sophie Duc Karim Bensalah Pierre Bigot Philippe Paparel Jean-Baptiste Beauval Laurent Salomon Alexandre De La Taille Hervé Lang François-Xavier Nouhaud José Batista Da Costa Charles Dariane Hervé Baumert Morgan Roupret Thibaut Waeckel Cédric Lebacle Jean-Alexandre Long François Henon Jean-Jacques Patard Nicolas Doumerc Arnaud Mejean Marie-Neige Videau Jean-Christophe Bernhard Postoperative outcomes of elderly patients undergoing partial nephrectomy Scientific Reports |
author_facet |
Alexandre Ingels Sophie Duc Karim Bensalah Pierre Bigot Philippe Paparel Jean-Baptiste Beauval Laurent Salomon Alexandre De La Taille Hervé Lang François-Xavier Nouhaud José Batista Da Costa Charles Dariane Hervé Baumert Morgan Roupret Thibaut Waeckel Cédric Lebacle Jean-Alexandre Long François Henon Jean-Jacques Patard Nicolas Doumerc Arnaud Mejean Marie-Neige Videau Jean-Christophe Bernhard |
author_sort |
Alexandre Ingels |
title |
Postoperative outcomes of elderly patients undergoing partial nephrectomy |
title_short |
Postoperative outcomes of elderly patients undergoing partial nephrectomy |
title_full |
Postoperative outcomes of elderly patients undergoing partial nephrectomy |
title_fullStr |
Postoperative outcomes of elderly patients undergoing partial nephrectomy |
title_full_unstemmed |
Postoperative outcomes of elderly patients undergoing partial nephrectomy |
title_sort |
postoperative outcomes of elderly patients undergoing partial nephrectomy |
publisher |
Nature Publishing Group |
series |
Scientific Reports |
issn |
2045-2322 |
publishDate |
2021-08-01 |
description |
Abstract To describe clinical outcomes of patients aged 75 years and above after partial nephrectomy (PN), and to assess independent factors of postoperative complications. We retrospectively reviewed information from our multi-institutional database. Every patient over 75 years old who underwent a PN between 2003 and 2016 was included. Peri-operative and follow up data were collected. Multivariate logistic regression was performed to determine independent predictive factors of postoperative complications. We reviewed 191 procedures including 69 (40%) open-surgery, and 122 (60%) laparoscopic procedures, of which 105 were robot-assisted. Median follow-up was 25 months. The mean age was 78 [75–88]. The American Society of Anesthesiologist’s score was 1, 2, 3 and 4 in 10.5%, 60%, 29% and 0.5% of patients respectively. The mean tumor size was 4.6 cm. Indication of PN was elective in 122 (65%) patients and imperative in 52 patients (28%). The median length of surgery was 150(± 60) minutes, and the median estimated blood loss 200 ml. The mean glomerular filtration rate was 71.5 ml/minute preoperatively, and 62 ml/min three months after surgery. The severe complications (Clavien III-V) rate was 6.2%. On multivariate analysis, the robotic-assisted procedure was an independent protective factor of medical postoperative complications (Odds Ration (OR) = 0.31 [0.12–0.80], p = 0.01). It was adjusted for age and RENAL score, robotic-assisted surgery (OR = 0.22 [0.06–0.79], p = 0.02), and tumor size (OR = 1.13 [1.02–1.26], p = 0.01), but the patients age did not forecast surgical complications. Partial nephrectomy can be performed safely in elderly patients with an acceptable morbidity, and should be considered as a viable treatment option. Robotic assistance is an independent protective factor of postoperative complications. |
url |
https://doi.org/10.1038/s41598-021-96676-y |
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