Treatment Modalities and Risks of Complication for Patients With Localized Renal Cell Carcinoma Aged 75 and Older

Chalairat Suk-ouichai, Hiten D. Patel, Kent T. Sato, Shilajit D. Kundu, Ashley E. Ross, Kent T. Perry*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Objectives: Partial (PN)/radical (RN) nephrectomy is the standard treatment for localized renal-cell carcinoma (RCC). The potential risks of these procedures are concerns for the elderly. We evaluated perioperative outcomes/survival for patients aged ≥ 75 years with localized RCC who underwent PN, RN, or thermal ablation (TA). Methods: Localized RCC patients undergoing PN/RN/TA (2000–2023) were retrospectively reviewed. Logistic-regression assessed factors associated with major complications. Kaplan-Meier estimated survival. Results: A total of 278 patients (≥ 75 years) with RCC who received intervention (107RN, 101PN, and 70TA) were identified. Median age was 78 years. PN patients were younger than other cohorts (77 vs. 79, p = 0.006). Patients with cancer comorbidities underwent TA than PN/RN (93% vs. 88%/76%, respectively). Median tumor size was 4.0, 3.0, and 2.6 cm in RN, PN, and TA cohorts, respectively. RN patients had more complex masses compared to other cohorts (9 vs. 7, p < 0.001). Postoperative complications were significantly greater among PN patients (p = 0.03), but there was no significant difference in Clavien ≥ 3 complications. Peripheral vascular disease (PVD) was associated with Clavien ≥ 3 complications on multivariable analysis (p = 0.03). RN was performed at a stable rate while PN decreased in favor of TA. There was no significant difference in RCC-/non-RCC-specific survival among treatment modalities. Conclusions: It is important to make informed decisions about treating RCC in the elderly to reduce morbidity/mortality. PVD could be a determining factor favoring TA for amenable tumors.

Original languageEnglish (US)
JournalJournal of surgical oncology
DOIs
StateAccepted/In press - 2024

Keywords

  • elderly
  • localized cancer
  • nephrectomy
  • renal cell carcinoma
  • small renal mass
  • thermal ablation

ASJC Scopus subject areas

  • Surgery
  • Oncology

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