Kidney surgery safe in select elderly patients

17 oct 2008--Surgery appears to be a safe option in certain elderly patients with kidney cancer, German researchers have found.
However, it "certainly depends on a patient's health, fitness and wishes," lead investigator Dr. Frederik C. Roos told Reuters Health. "If the patient wants to undergo surgery, according to our results, it is a possible and safe procedure in carefully selected cases."
Roos and colleagues at Johannes Gutenberg-University, Mainz reviewed the records of 1,625 patients who had surgery at their institution because of solid tumors suspected to be renal cell carcinoma -- the most common form of kidney cancer.
In all, 62 of the patients were more than 80 years old; 45 had radical nephrectomy (surgical removal of the kidney) and the remaining 17 had a less radical surgery called "nephron-sparing" surgery. Nephrons are key units both anatomically and functionally of the kidney that filter waste products from the blood and forms urine.
There were no deaths around the time of surgery, Roos and colleagues report. While 56 of the patients were found to have renal cell carcinoma, 6 had benign lesions.
Patients who had nephron-sparing surgery tended to have fewer complications. However, complications were minor, overall.
The 5-year overall survival rate was 68 percent and the cancer-specific survival rate was 85 percent. All of the patients survived a median of 7.4 years following surgery. Median survival for those with renal cell carcinoma had not been reached at the time of last follow-up.
"Despite the excellent outcome," say the investigators, an evaluation of co-occurring illnesses before surgery is important. "And, of course," added Roos, "there are other treatment options ... especially for this age group. These have to be discussed with the patient regarding their benefits and outcomes."
SOURCE: BJU International, September 2008.