MP26-12 TRIFECTA OUTCOMES OF PARTIAL NEPHRECTOMY IN PATIENTS OVER 75 YEARS OLD: A MULTI-INSTITUTIONAL STUDY: ANALYSIS OF THE RENAL SURGERY IN ELDERLY (RESURGE) GROUP

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I1 Apr 2018MP26-12 TRIFECTA OUTCOMES OF PARTIAL NEPHRECTOMY IN PATIENTS OVER 75 YEARS OLD: A MULTI-INSTITUTIONAL STUDY: ANALYSIS OF THE RENAL SURGERY IN ELDERLY (RESURGE) GROUP Ahmet Bindayi, Riccardo Autorino, Madhumitha Reddy, Stephen Ryan, Giuseppe Simone, Michele Gallucci, Gabriele Tuderti, Zachary Hamilton, Kendrick Yim, Manuela Costantini, Andrea Minervini, Andrea Mari, Marco Carini, Daniel Eun, Koon Rha, Bo Yang, Alessandro Larcher, Umberto Capitanio, Aryeh Keehn, Francesco Porpiglia, Ricacardo Bertolo, Sisto Perdona, Giuseppe Quarto, James Porter, Michael Liao, Matteo Ferro, Ottavio De Cobelli, Geert De Naeyer, Kidon Chang, Alexander Kutikov, David Chen, Marc Smaldone, Luigi Schips, Francesco Berardinelli, Wesley White, Chao Zang, Ken Jacobsohn, Peter Langenstroer, Peter Dietrich, Prokar Dasgupta, Nicole de Luyk, Ben Challacombe, Uzoma Anele, Lance Hampton, Clayton Lau, Patrick Kilday, Chandru Sundaram, Jay Sulek, Robert Uzzo, Alexandre Mottrie, Francesco Montorsi, and Ithaar Derweesh Ahmet BindayiAhmet Bindayi More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Madhumitha ReddyMadhumitha Reddy More articles by this author , Stephen RyanStephen Ryan More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Michele GallucciMichele Gallucci More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Zachary HamiltonZachary Hamilton More articles by this author , Kendrick YimKendrick Yim More articles by this author , Manuela CostantiniManuela Costantini More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Andrea MariAndrea Mari More articles by this author , Marco CariniMarco Carini More articles by this author , Daniel EunDaniel Eun More articles by this author , Koon RhaKoon Rha More articles by this author , Bo YangBo Yang More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Aryeh KeehnAryeh Keehn More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Ricacardo BertoloRicacardo Bertolo More articles by this author , Sisto PerdonaSisto Perdona More articles by this author , Giuseppe QuartoGiuseppe Quarto More articles by this author , James PorterJames Porter More articles by this author , Michael LiaoMichael Liao More articles by this author , Matteo FerroMatteo Ferro More articles by this author , Ottavio De CobelliOttavio De Cobelli More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Kidon ChangKidon Chang More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , David ChenDavid Chen More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Luigi SchipsLuigi Schips More articles by this author , Francesco BerardinelliFrancesco Berardinelli More articles by this author , Wesley WhiteWesley White More articles by this author , Chao ZangChao Zang More articles by this author , Ken JacobsohnKen Jacobsohn More articles by this author , Peter LangenstroerPeter Langenstroer More articles by this author , Peter DietrichPeter Dietrich More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , Nicole de LuykNicole de Luyk More articles by this author , Ben ChallacombeBen Challacombe More articles by this author , Uzoma AneleUzoma Anele More articles by this author , Lance HamptonLance Hampton More articles by this author , Clayton LauClayton Lau More articles by this author , Patrick KildayPatrick Kilday More articles by this author , Chandru SundaramChandru Sundaram More articles by this author , Jay SulekJay Sulek More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.870AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While increasingly utilized, Partial nephrectomy (PN) in the elderly is controversial due to several factors including advanced co-morbidities associated with decreasing life expectancy, and potential impact of procedure specific complications due to patient frailty. We aimed to evaluate the short-term outcomes of partial nephrectomy in patients over 75 years old using Trifecta as s composite outcome of Surgical Quality. METHODS Multicenter retrospective analysis of patients with aged 75 years or older who underwent PN [REnal SURGery in Elderly (RESURGE) Group]. Primary outcome was achievement of trifecta [negative surgical margin, no urological complications, and ≥90% eGFR (glomerular filtration rate) recovery]. Secondary outcomes included overall survival, de novo chronic kidney disease (CKD) stage III. Multivariable analysis (MVA) was used to evaluate risk factors associated with achieving trifecta and renal functional outcomes. Kaplan Meier analysis was used to calculate survival probability and freedom from new onset of CKD stage III. RESULTS We analyzed 949 patients (mean age 78.3 years, median follow-up 32 months) Trifecta rate was 39.4% (374). Compared to patients who did not achieve Trifecta, patients with positive trifecta had lower preoperative eGFR (57.3 vs. 62.5, p=0.028), greater frequency of cT1 disease (96.4% vs. 94.6%, p=0.028), lower and lower RENAL score (6.4 vs. 7.2, p=0.001). Trifecta positive patients similar less estimated blood loss (204.2 ml vs. 328.4 ml, p=0.003) but similar ischemia times (22.8 vs. 23.8 min, p=0.609), and 30 day readmission rates (1.3% vs. 3.6%, p=0.650). MVA for predictive factors for Trifecta revealed Low and intermediate RENAL score [HR 6.8-4.8, p=0.011 to 0.039, respectively], and minimal invasive surgery (MIS) [HR 1.70; p=0.039] as being associated with higher likelihood to achieve Trifecta. Kaplan Meier analysis did not demonstrate difference in overall survival among patients with cT1a and cT1b+ and with and without positive Trifecta (p=0.189). MVA for predictors for de novo CKD Stage III showed lack of trifecta (HR 9.1, p=0.001) as an independent risk factor. CONCLUSIONS Partial nephrectomy in older patients is feasible with acceptable short-term morbidity and renal functional quality outcomes. Achievement of Trifecta as a short term quality composite outcome also correlated with decreased risk of longer term functional sequelae such as development of CKD. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e341 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ahmet Bindayi More articles by this author Riccardo Autorino More articles by this author Madhumitha Reddy More articles by this author Stephen Ryan More articles by this author Giuseppe Simone More articles by this author Michele Gallucci More articles by this author Gabriele Tuderti More articles by this author Zachary Hamilton More articles by this author Kendrick Yim More articles by this author Manuela Costantini More articles by this author Andrea Minervini More articles by this author Andrea Mari More articles by this author Marco Carini More articles by this author Daniel Eun More articles by this author Koon Rha More articles by this author Bo Yang More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Aryeh Keehn More articles by this author Francesco Porpiglia More articles by this author Ricacardo Bertolo More articles by this author Sisto Perdona More articles by this author Giuseppe Quarto More articles by this author James Porter More articles by this author Michael Liao More articles by this author Matteo Ferro More articles by this author Ottavio De Cobelli More articles by this author Geert De Naeyer More articles by this author Kidon Chang More articles by this author Alexander Kutikov More articles by this author David Chen More articles by this author Marc Smaldone More articles by this author Luigi Schips More articles by this author Francesco Berardinelli More articles by this author Wesley White More articles by this author Chao Zang More articles by this author Ken Jacobsohn More articles by this author Peter Langenstroer More articles by this author Peter Dietrich More articles by this author Prokar Dasgupta More articles by this author Nicole de Luyk More articles by this author Ben Challacombe More articles by this author Uzoma Anele More articles by this author Lance Hampton More articles by this author Clayton Lau More articles by this author Patrick Kilday More articles by this author Chandru Sundaram More articles by this author Jay Sulek More articles by this author Robert Uzzo More articles by this author Alexandre Mottrie More articles by this author Francesco Montorsi More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...