Renal tumour surgery in elderly patients

OBJECTIVE

To analyse morbidity, renal function and oncological outcome in patients aged ≥80 years who had surgery for renal tumours, as in the elderly such surgery is controversial in relation to life‐expectancy and other causes of death.

PATIENTS AND METHODS

Between 1990 and 2006, in our institution 1625 patients had surgery to treat solid renal tumours suspected to be renal cell carcinoma (RCC); 62 (4%) were aged ≥80 years (mean 82.5), and 73% of these elderly patients had radical nephrectomy (RN) and 27% nephron‐sparing surgery (NSS). Results The median (range) follow‐up was 3.1 (0.2–14.1) years (89% of the patients). There was no perioperative mortality. There were only minor complications in 47% of patients, most (34%) being temporary increases in serum creatinine level. Histopathologically, 10% of the 62 patients had benign lesions and 90% had RCC. Of the 56 patients with RCC, the stage was pT1a in 34%, pT1b in 25%, pT2 in 5% and pT3 in 36%. For those treated with RN the median (range) serum creatinine level before and after RN was 1.0 (0.7–1.8) and 1.4 (1.0–2.8) mg/dL (P < 0.05), and for those treated with NSS were 1.1 (0.7–4.4) and 1.2 (0.7–4.8) mg/dL (not significant), respectively. The 5‐year overall survival was 68% and the cancer‐specific survival was 85%.

CONCLUSIONS

Surgery for renal tumours is safe in elderly patients, with a low perioperative morbidity and a good overall survival rate. Patients should be selected carefully according to comorbidities, biological age and social support.