Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group

Background: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (<75 vs.≥ 75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p < 0.01) and higher ASA score (ASA >2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p < 0.01), EBL ≥ 500 cc (OR 3.34, p < 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)

Adrenalectomía laparoscópica: ¿abordaje retroperitoneal posterior o transperitoneal lateral? / Laparoscopic Adrenalectomy: posterior retroperitoneoscopic or lateral transperitoneal approach?

Objetivo: comparar los resultados obtenidos en adrenalectomía retroperitoneoscópica posterior (ARP) con los obtenidos por vía transperitoneal lateral (ATL) a corto y mediano plazo. Material y métodos: estudio de cohortes prospectivo. Se incluyeron 22 pacientes a quienes se les realizaron 24 adrenalectomías (12 ARP y 12 ATL) entre los meses de enero de 2015 y mayo de 2016. En el grupo ARP se realizó a 1 paciente adrenalectomía bilateral simultánea y a 1 paciente, bilateral sincrónica. Fueron comparados datos basales, clínicos, quirúrgicos y evolutivos. Resultados: la mediana de tiempo de seguimiento fue de 6,5 meses (r 1-16). Los grupos ARP y ATL fueron comparables en edad, sexo, BMI y presencia de cirugías previas. Los adenomas fueron las lesiones predominantes (41,7% en cada grupo). El promedio de tiempo operatorio en ART y ATL fue 104,3 ± 21,2 y 146 ± 32,9 minutos, respectivamente (p 0,05). No hallamos diferencias en tiempo de internación, sangrado y complicaciones. Todos los pacientes lograron curación clínica. Conclusiones: la técnica ARP es una vía segura, con resultados comparables a ATL y menor tiempo operatorio. También permite intervenir de manera simultánea y sincrónica ambas glándulas adrenales sin necesidad de reposicionar al paciente.

Objetive: to compare the results of posterior retroperitoneoscopic (PRA) or lateral transperitoneal approach (LTA) in laparoscopic adrenalectomy in the short and medium term. Material y methods: prospective cohort study. We included 22 patients who underwent 24 adrenalectomies (12 PRA and 12 LTA) between January 2015 and May 2016. In the PRA group, two simultaneous bilateral laparoscopic adrenalectomies were performed (1 synchronous bilateral adrenalectomy). Baseline, clinical and surgical outcome were compared. Results: the median follow-up time was 6.5 months (range: 1-16). The PRA and LTA groups were comparable in age, gender, BMI and presence of previous surgeries. Adenomas were the predominant lesions (41.7% in each group). The average operating time in PRA and LTA was 104.3 ± 21.2 and 146 ± 32.9 minutes, respectively (p=0.05). We found no differences in length of hospital stay, bleeding and complications. All patients achieved clinical cure. Conclusions: the PRA technique is a safe approach, with results comparable to LTA and shorter operating time. It also allows to intervene simultaneously and synchronously both adrenal glands without the need of repositioning the patient.