• Adrián M Garza-Gangemi, Ricardo A Castillejos-Molina, Guillermo Gueglio, Ignacio P Tobia Gonzalez, Alberto M Jurado, Luis Meza-Montoya, Carlos H Scorticati, Walter Henriques-da-Costa, Juan Yandian, Luis Ubillos, Sidney Glina, Marcos Tobias-Machado, Oscar Rodríguez-Faba, Carlos Ameri, Alejandro Nolazco, Pablo Martinez, Gustavo Franco-Carvalhal, Ruben G Bengio, Leandro Cristian Arribillaga, Raúl Langenhin, Diego Muguruza, José G Campos-Salcedo, Edgar I Bravo-Castro, Pablo A Mingote, Nicolás Ginestar, Ana M Autran-Gomez, Roberto Puente, Ricardo Decia, Gustavo Cardoso-Guimarães, Joan Palou-Redorta, Diego Abreu-Clavijo, Stenio de-Cassio-Zequi, Francisco T Rodriguez-Covarrubias, and Latin American Renal Cancer Group (LARCG).
• Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
• Rev Invest Clin. 2020 May 7; 72 (5).

BackgroundThe incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies.ObjectiveThe aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age.MethodsThis 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 (less than 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.ResultsThere were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p less than 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 less than 0.01), EBL ≥ 500 cc (OR 3.34, p less than 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications.ConclusionsSurgical 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.

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