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RESEARCH PRODUCT

Perioperative morbidity and renal function in young and elderly patients undergoing elective nephron-sparing surgery or radical nephrectomy for renal tumours larger than 4 cm

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Objective To analyse renal function, perioperative morbidity and overall survival (OS) in patients aged 65 years treated by radical nephrectomy (RN) or elective nephron-sparing surgery (NSS) for renal tumours > 4 cm. Patients and methods From our database, we identified 829 patients with renal tumours > 4 cm treated by either RN (n = 641) or NSS (n= 188) at our institution between 1981 and 2007. After excluding patients with imperative indication and metastases, we identified retrospectively 81 patients aged 65 years (elderly patients) treated for renal tumours > 4 cm. In all, 36 and 33 patients underwent NSS and 45 and 52 patients underwent RN in the young and elderly group, respectively. Preoperative and periodically postoperative serum creatinin values were used to estimate glomerular filtration rate (GFR). Chronic kidney disease (CKD) was defined as GFR Results The median (range) tumour size in young patients was larger compared with that of elderly patients, i.e. 6 (4.2-14.0) cm vs 5 (4.2-16.0) cm, with P Conclusion Our findings suggest that performing NSS for tumours > 4 cm when feasible in young and carefully selected elderly patients is more beneficial for maintaining long-term renal function. Regardless of age, patients undergoing RN for renal tumours > 4 cm developed more new onsets of CKD than patients treated by elective NSS. The complication rate did not differ between the age groups or between types of surgery.