A Nonrandomized Prospective Comparison of Robotic-assisted Partial Nephrectomy in the Elderly to a Younger Cohort: An Analysis of 339 Patients With Intermediate-term Follow-up

ObjectiveTo assess the role of robotic-assisted partial nephrectomy (RAPN) in elderly patients focusing on perioperative, functional, and oncologic outcomes in comparison with a younger cohort.Materials and MethodsFrom a prospectively maintained institutional review board–approved database, 339 patients were divided into 2 groups defined by age ≥70 (n = 71) or <70 years (n = 268) at the time of RAPN. They were compared for perioperative outcomes and complications, including risk of chronic kidney disease (CKD) stage progression. The standard t test and chi square test were used for continuous and categorical variables, respectively. Logistic regression identified risk factors for progression of renal dysfunction. Kaplan-Meier estimates modeled tumor recurrence at 368 and 462 days in the elderly and young, respectively.ResultsElderly patients were more likely to have hypertension (86% vs 60%; P <.001) or coronary artery disease (27% vs 9%; P <.001), and rates of chronic obstructive pulmonary disorder and diabetes were also higher. Preoperative estimated glomerular filtration rate was significantly lower in the elderly (70 vs 82 mL/min/1.73 m2; P <.001). Twenty-four percent of elderly patients progressed in CKD stage as compared to 14% in the younger cohort (P = .08). Elderly age was not a statistically significant risk factor for CKD progression (relative risk, 2.34; 95% confidence interval, 0.81-6.05; P = .11). Surgical and medical complication rates were similar between the cohorts (P = .75 and .80, respectively) as were Kaplan-Meier estimates of risk of tumor recurrence (P = .47). Limitations include nonrandomized, single-center study, and intermediate-term follow-up for oncologic outcomes.ConclusionElderly patients undergoing RAPN had no increased risk of perioperative complications. CKD progression and risk of oncologic recurrence were similar to younger patients at intermediate-term follow-up.