Long-term oncologic and functional outcomes after robot-assisted partial nephrectomy in elderly patients.

BACKGROUND: The aim of this study was to assess the long-term oncologic and functional outcomes in elderly patients having undergone robot-assisted partial nephrectomy (RAPN) for renal cancer (RC).

METHODS: Sixty one patients out of 323 who underwent RAPN for localized RC between July 2009 and March 2016 in our high volume robotic surgery center (>800 procedures/year), had 70 years or more. Inclusion criteria of the study were age ≥70 years; pathological confirmed RCC and ASA score ≤3. All patients were stratified according to PADUA classification system in three groups: < 7 points, 8-9 points, > 10 points. Trifecta was defined as a warm ischemia time (WIT) less then 25min, negative surgical margins and no perioperative complications.

RESULTS: A total of 52 patients were included; median follow-up was 47 months. Median age was 74 yrs. (IQR 72-76.5). Complication rate was 15.4%. Trifecta failure was associated to PADUA score (p=0.02), and tumor diameter (p=0.04). Renal function was altered in 10 (19.2%) patients before surgery and at last follow-up in 11 (21.1%) patients (CKD stage>2) The DFS, OS and CSS were 89.33%, 90.06% and 94.4%, respectively.

CONCLUSIONS: In a high-volume center, robot-assisted approach is feasible and safe in surgical fit elderly patients with good long-term oncologic outcomes.