Cytoreductive nephrectomy in the elderly: a population-based cohort from the USA.

TY - JOUR

T1 - Cytoreductive nephrectomy in the elderly: a population-based cohort from the USA.

AU - Sun, Maxine

AU - Abdollah, Firas

AU - Schmitges, Jan

AU - Bianchi, Marco

AU - Tian, Zhe

AU - Shariat, Shahrokh F

AU - Zorn, Kevin

AU - Pharand, Daniel

AU - Widmer, Hugues

AU - Graefen, Markus

AU - Montorsi, Francesco

AU - Perrotte, Paul

AU - Karakiewicz, Pierre I

PY - 2012

Y1 - 2012

N2 - Study Type - Therapy (cohort) Level of Evidence?2b What's known on the subject? and What does the study add? While cytoreductive nephrectomy is associated with a survival benefit in the context of metastatic renal cell carcinoma, the rates of morbidity and perioperative mortality remain non-negligible. For example, perioperative mortality may be as high as 21% in elderly patients. The study shows that perioperative death amongst the elderly was substantially lower than what was previously reported from a single institutional report. Nonetheless, postoperative adverse outcomes were non-negligible in elderly patients relative to their younger counterparts. In consequence, these rates should be discussed at informed consent and a rigorous patient selection remains essential. OBJECTIVE: •? To examine the rate of perioperative mortality (PM), and other adverse outcomes in 'elderly' patients treated with cytoreductive nephrectomy (CNT). MATERIAL AND METHODS: •? Patients who underwent CNT for metastatic renal cell carcinoma were abstracted from the Nationwide Inpatient Sample (1998-2007). 'Elderly' was defined as ?75 years, according to previous definition. •? Endpoints consisted of PM, intraoperative and postoperative complications, blood transfusions and length of stay. •? We adjusted for the effect of elderly status within five separate logistic regression models. Covariates consisted of comorbidity, race, gender, year of surgery and hospital region. RESULTS: •? Overall, CNT was performed in 504 (15.3%) elderly patients and in 2796 (84.7%) 'younger' patients (

AB - Study Type - Therapy (cohort) Level of Evidence?2b What's known on the subject? and What does the study add? While cytoreductive nephrectomy is associated with a survival benefit in the context of metastatic renal cell carcinoma, the rates of morbidity and perioperative mortality remain non-negligible. For example, perioperative mortality may be as high as 21% in elderly patients. The study shows that perioperative death amongst the elderly was substantially lower than what was previously reported from a single institutional report. Nonetheless, postoperative adverse outcomes were non-negligible in elderly patients relative to their younger counterparts. In consequence, these rates should be discussed at informed consent and a rigorous patient selection remains essential. OBJECTIVE: •? To examine the rate of perioperative mortality (PM), and other adverse outcomes in 'elderly' patients treated with cytoreductive nephrectomy (CNT). MATERIAL AND METHODS: •? Patients who underwent CNT for metastatic renal cell carcinoma were abstracted from the Nationwide Inpatient Sample (1998-2007). 'Elderly' was defined as ?75 years, according to previous definition. •? Endpoints consisted of PM, intraoperative and postoperative complications, blood transfusions and length of stay. •? We adjusted for the effect of elderly status within five separate logistic regression models. Covariates consisted of comorbidity, race, gender, year of surgery and hospital region. RESULTS: •? Overall, CNT was performed in 504 (15.3%) elderly patients and in 2796 (84.7%) 'younger' patients (

M3 - SCORING: Journal article

VL - 109(12)

SP - 1807

EP - 1812

JO - BJU INT

JF - BJU INT

SN - 1464-4096

ER -