Email this article Robot-assisted surgery of renal cell carcinoma in comorbid and frail patients
- Authors: Simonyan A.M.1, Mosoyan M.S.1,2, Shanava G.S.1,3, Gilev E.S.1, Vasilev A.A.1, Fedorov D.A.1
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Affiliations:
- Almazov National Medical Research Centre
- Academician I.P. Pavlov First St. Petersburg State Medical University
- Dzhanelidze Research Institute of Emergency Medicine
- Issue: Vol 14, No 1 (2024)
- Pages: 5-13
- Section: Original articles
- URL: https://ogarev-online.ru/uroved/article/view/257393
- DOI: https://doi.org/10.17816/uroved609566
- ID: 257393
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Abstract
BACKGROUND: Renal cell carcinoma is predominantly observed in elderly patients. Many of them have multiple comorbidities, which can limit the feasibility of surgical treatment. The search for an optimal approach of radical treatment for comorbid and frail patients remains a current challenge.
AIM: To evaluate the perioperative outcomes of robot-assisted partial nephrectomy and radical nephrectomy in comorbid and frail patients with renal cell carcinoma.
MATERIALS AND METHODS: At the Almazov National Medical Research Centre we retrospectively studied the results of 118 comorbid and frail patients who underwent robot-assisted surgeries for localized renal cell carcinoma from 2012 to 2022. Mean age of men was 65.7 ± 11.4 years, and women was 61.3 ± 13.1 years. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Frailty was determined using a modified Frailty index (mFI-11). Robot-assisted partial nephrectomy and radical nephrectomy were perfomed by single experienced robotic surgeon. Perioperative functional outcomes were assessed. Renal function was evaluated based on glomerular filtration rate (GFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula before surgery and at 1.3, and 6 months after surgery.
RESULTS: Among 118 patients, 71 (60.2%) underwent robot-assisted partial nephrectomy, while 47 (39.8%) underwent radical nephrectomy. Postoperative complications occurred in 15 (12.7%) of patients for robot-assisted surgeries. There were no positive surgical margins. Mortality in the early postoperative period amounted to 1.7% and was associated with the development of acute cardiovascular failure.
CONCLUSIONS: Robot-assisted partial nephrectomy and radical nephrectomy for renal cell carcinoma in comorbid and “fragile” patients — the safest and optimal method of treatment, accompanied by minimal perioperative complications and mortality.
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##article.viewOnOriginalSite##About the authors
Artur M. Simonyan
Almazov National Medical Research Centre
Author for correspondence.
Email: artsaimon143@gmail.com
Postgraduate student
Russian Federation, 2 Akkuratova st., Saint Petersburg, 191014Mkrtich S. Mosoyan
Almazov National Medical Research Centre; Academician I.P. Pavlov First St. Petersburg State Medical University
Email: moso03@yandex.ru
ORCID iD: 0000-0003-3639-6863
SPIN-code: 5716-9089
Scopus Author ID: 57208982777
MD, Dr. Sci. (Medicine), Professor
Russian Federation, 2 Akkuratova st., Saint Petersburg, 191014; 6–8 Lva Tolstogo st., Saint Petersburg, 197022Gocha Sh. Shanava
Almazov National Medical Research Centre; Dzhanelidze Research Institute of Emergency Medicine
Email: dr.shanavag@mail.ru
SPIN-code: 1706-7410
MD, Cand. Sci. (Medicine)
Russian Federation, 2 Akkuratova st., Saint Petersburg, 191014; Saint PetersburgEvgeny S. Gilev
Almazov National Medical Research Centre
Email: jackpafosky@gmail.com
SPIN-code: 5773-4804
Assistant of the Department of Urology
Russian Federation, 2 Akkuratova st., Saint Petersburg, 191014Artem A. Vasilev
Almazov National Medical Research Centre
Email: scapaflow12@gmail.com
Assistant of the Department of Urology
Russian Federation, 2 Akkuratova st., Saint Petersburg, 191014Dmitriy A. Fedorov
Almazov National Medical Research Centre
Email: tvoiurolog@gmail.com
ORCID iD: 0000-0002-6371-4620
SPIN-code: 4359-8143
Assistant of the Department of Urology
Russian Federation, 2 Akkuratova st., Saint Petersburg, 191014References
- Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–249. doi: 10.3322/caac.21660
- Capitanio U, Bensalah K, Bex A, et al. Epidemiology of renal cell carcinoma. Eur Urol. 2019;75(1):74–84. doi: 10.1016/j.eururo.2018.08.036
- Padala SA, Barsouk A, Thandra KC, et al. Epidemiology of renal cell carcinoma. World J Oncol. 2020;11(3):79–87. doi: 10.14740/wjon1279
- Brivio P, Paladini MS, Racagni G, et al. From healthy aging to frailty: In search of the underlying mechanisms. Curr Med Chem. 2019;26(20):3685–3701. doi: 10.2174/0929867326666190717152739
- Kingston A, Robinson L, Booth H, et al. Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model. Age Ageing. 2018;47(3):374–380. doi: 10.1093/ageing/afx201
- Feinstein AR. The pre-therapeutic classification of comorbidity in chronic disease. J Chronic Dis. 1970;23(7):455–468. doi: 10.1016/0021-9681(70)90054-8
- Oganov RG, Denisov IN, Simanenkov VI, et al. Comorbidities in practice. Clinical guidelines. Cardiovascular Therapy and Prevention. 2017;16(6):5–56. EDN: ZVZZGR doi: 10.15829/1728-8800-2017-6-5-56
- Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383. doi: 10.1016/0021-9681(87)90171-8
- Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3): M146–M156. doi: 10.1093/gerona/56.3.m146
- Dent E, Martin FC, Bergman H, et al. Management of frailty: opportunities, challenges, and future directions. Lancet. 2019;394(10206):1376–1386. doi: 10.1016/S0140-6736(19)31785-4
- Wleklik M, Uchmanowicz I, Jankowska EA, et al. Multidimensional approach to frailty. Front Psychol. 2020;11:564. doi: 10.3389/fpsyg.2020.00564
- Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology Guidelines on renal cell carcinoma: The 2022 update. Eur Urol. 2022;82(4):399–410. doi: 10.1016/j.eururo.2022.03.006
- Shapiro DD, Wells SA, Best SL, et al. Comparing outcomes for patients with clinical T1b renal cell carcinoma treated with either percutaneous microwave ablation or surgery. Urology. 2020;135:88–94. doi: 10.1016/j.urology.2019.09.024
- Velanovich V, Antoine H, Swartz A, et al. Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res. 2013;183(1):104–110. doi: 10.1016/j.jss.2013.01.021
- Kasiske BL, Wheeler DC. Kidney disease: Improving global outcomes — an update. Nephrol Dial Transplant. 2014;29(4):763–769. doi: 10.1093/ndt/gft441
- Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9): 604–612. doi: 10.7326/0003-4819-150-9-200905050-00006
- Rosiello G, Re C, Larcher A, et al. The effect of frailty on post-operative outcomes and health care expenditures in patients treated with partial nephrectomy. Eur J Surg Oncol. 2022;48(8):1840–1847. doi: 10.1016/j.ejso.2022.01.001
- Rosiello G, Palumbo C, Deuker M, et al. Partial nephrectomy in frail patients: Benefits of robot-assisted surgery. Surg Oncol. 2021;38:101588. doi: 10.1016/j.suronc.2021.101588
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