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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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8d82c46895574699a1b40680f0a407f7
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spelling	oai:doaj.org-article:8d82c46895574699a1b40680f0a407f72021-12-02T16:34:54ZPostoperative outcomes of elderly patients undergoing partial nephrectomy10.1038/s41598-021-96676-y2045-2322https://doaj.org/article/8d82c46895574699a1b40680f0a407f72021-08-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-96676-yhttps://doaj.org/toc/2045-2322Abstract 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.Alexandre IngelsSophie DucKarim BensalahPierre BigotPhilippe PaparelJean-Baptiste BeauvalLaurent SalomonAlexandre De La TailleHervé LangFrançois-Xavier NouhaudJosé Batista Da CostaCharles DarianeHervé BaumertMorgan RoupretThibaut WaeckelCédric LebacleJean-Alexandre LongFrançois HenonJean-Jacques PatardNicolas DoumercArnaud MejeanMarie-Neige VideauJean-Christophe BernhardNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q 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
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.
format	article
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
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 Portfolio
publishDate	2021
url	https://doaj.org/article/8d82c46895574699a1b40680f0a407f7
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Postoperative outcomes of elderly patients undergoing partial nephrectomy

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