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Complications common after nephrectomy in octogenarians

NEW YORK (Reuters Health) – More than a third of patients over 80 who have nephrectomy for renal cell carcinoma will have complications, new data suggest.

It’s likely that the number of octogenarians with curable cancer will be rising, given better imaging and longer life expectancies, French researchers say. And because the benefit of surgery in octogenarians is controversial, some asymptomatic elderly patients may be treated with active surveillance, they noted in a July 20 online paper in The Journal of Urology.

Led by Dr. Julien Berger of Dupuytren University Hospital Limoges, they sought to clarify the risks and benefits of surgery in these older patients by reviewing data on 180 patients who were at least 80 years old when they had kidney resection between 2002 and 2011.

In all, 22 had partial nephrectomy and 158 had radical nephrectomy. In 47 cases, surgery was done laparoscopically.

Almost a third of patients (31%) needed transfusions. Overall, 136 postoperative complications were recorded in 70 patients (38.8%). In 5%, complications required surgical re-exploration. Six patients (3.3%) died of postoperative complications.

Twenty-eight patients had one complication, 25 had two and 17 had three or more.

Cardiac disease was the most frequent complication (10%), followed by confusion (7.2%).

Eastern Cooperative Oncology Group Performance Status (ECOG-PS) of 2 to 4 and a preoperative glomerular filtration rate (GFR) less than 30 mL/minute were independent predictive factors of morbidity.

Preoperative GFR has been previously reported to predict complications, and ECOG-PS is easy to use and reproducible, say the investigators, “which should help clinicians in determining good candidates for surgical treatment among octogenarian patients.”

Given these findings, the researchers conclude, “The risk of complications should be considered in decision making for patients with renal cell carcinoma older than age 80 years.”

Dr. Berger did not respond to requests for comments.


J Urol 2012.