Comparative assessment of perioperative and functional results of organ saving surgery for localized renal cell carcinoma in patients of different age groups

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Abstract

BACKGROUND: The number of older patients with kidney tumors is steadily increasing. Surgical methods are the main ones in the treatment of patients with localized forms of renal cell carcinoma, including the elderly.

AIM: to conduct a comparative analysis of perioperative data and functional results of surgical interventions for renal cell carcinoma in patients of different age groups.

MATERIALS AND METHODS: The study included 256 patients with kidney tumors (mean age 65.2 ± 8.6 years). 146 (57.0%) patients aged 56 to 64 years made up group I, and 110 (43.0%) patients aged 65 to 75 years — group II. In 210 (82.0%) patients, the tumor diameter did not exceed 4 cm (T1a), in 46 (18.0%) patients it ranged from 4 to 6.2 cm (T1b). Radical nephrectomy and partial nephrectomy were performed respectively in 44 (30.1%) and 102 (69.9%) patients of group I and 58 (52.7%) and 52 (47.3%) patients of group II. All operations were performed laparoscopically.

RESULTS: In patients of group I, the duration of radical nephrectomy was 115.0 ± 18.0 min, and partial nephrectomy — 135.5 ± 25.0 min (p < 0.0001), in patients of group II, 120.0 ± 20.5 and 138.0 ± 25.5 min (p < 0.0001), respectively. Warm ischemia time during partial nephrectomy was 17.6 ± 1.2 min in patients of group I and 18.2 ± 1.5 min in patients of group II (p = 0.25). The volume of blood loss in patients of both groups I and II was significantly higher during partial nephrectomy. The average volume of blood loss in patients of group I was 130.0 ± 20.0 ml when performing radical nephrectomy and 236.5 ± 20.0 ml when performing partial nephrectomy (p < 0.0001), and in group II — 125.0 ± 18.5 ml for radical nephrectomy and 246.0 ± 22.0 ml for partial nephrectomy (p < 0.0001). The frequency of significant complications did not differ in patients of groups I and II. Grade IIIa complications according to the Clavien–Dindo classification of surgical complications were observed in 5 (3.4%) patients of group I and 4 (3.9%) patients of group II (p > 0.05), and grade IIIb in 3 (2.1%) and 2 (1.8%) patients (p > 0.05). Intraoperative bleeding developed in 19 (7.4%) patients: in 13 (8.4%) of 154 patients with partial nephrectomy, and in 6 (5.9%) of 102 patients with radical nephrectomy. In the early postoperative period in patients of group I after radical nephrectomy and partial nephrectomy, normal glomerular filtration rates was observed in 34.0% and 54.0% of patients, respectively, and in group II — in 31.0% and 52.0% of patients, respectively. Renal function significantly decreased in patients of both groups after radical nephrectomy compared with partial nephrectomy (p < 0.05). The results of GFR 3 months after surgery improved in patients after partial nephrectomy, and did not change significantly in the radical nephrectomy group.

CONCLUSIONS: The results of the study showed no differences in perioperative parameters (volume of intraoperative blood loss, warm ischemia time) during radical nephrectomy and partial nephrectomy in patients aged 56–64 and 65–75 years. The functional results of partial nephrectomy in patients of both groups were better compared to patients after radical nephrectomy. Thus, our data indicate the justification for performing organ-preserving operations, including in elderly patients.

About the authors

Sergey V. Popov

Clinical Hospital of St. Luke; Kirov Military Medical Academy

Email: doc.popov@gmail.com
ORCID iD: 0000-0003-2767-7153
SPIN-code: 3830-9539
Scopus Author ID: 57197368945

MD, Dr. Sci. (Med.), urologist, chief physician, professor of the Urology Department

Russian Federation, Saint Petersburg; Saint Petersburg

Murad M. Mirzabekov

Clinical Hospital of St. Luke

Author for correspondence.
Email: muramura450h@gmail.com
ORCID iD: 0000-0001-5792-1589

urologist

Russian Federation, Saint Petersburg

Ruslan G. Guseinov

Clinical Hospital of St. Luke; Saint Petersburg State University

Email: rusfa@yandex.ru
ORCID iD: 0000-0001-9935-0243
SPIN-code: 4222-4601
Scopus Author ID: 57209859097

MD, Cand. Sci. (Med.), deputy chief Physician for Research, assistant of the Department of Hospital Surgery

Russian Federation, Saint Petersburg; Saint Petersburg

Evgenii V. Pomeshkin

Clinical Hospital of St. Luke

Email: pomeshkin@mail.ru
ORCID iD: 0000-0002-5612-1878
SPIN-code: 5661-1947

MD, Cand. Sci. (Med.), head of the Urological Division

Russian Federation, Saint Petersburg

Boris A. Neymark

Altai State Medical University

Email: neimark.b@mail.ru
ORCID iD: 0000-0001-8009-3777
SPIN-code: 7886-8442
Scopus Author ID: 6602800153

MD, Dr. Sci. (Med.), professor of the Department of Urology and Andrology with a Сourse of Additional Professional Education, head of the Urological Division

Russian Federation, Barnaul, Altai Region

Adylbek R. Urazmetov

Clinical Hospital of St. Luke

Email: urazmetow1997@gmail.com
ORCID iD: 0009-0008-9020-9890

urologist

Russian Federation, Saint Petersburg

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