Re: Cytoreductive Nephrectomy in the Elderly Patient: The M.D. Anderson Cancer Center Experience

摘要

The authors examined perioperative mortality after cytoreductive nephrectomy and stratified deaths according to patient age (>=75 yr vs. others). Within the study cohort of 404 patients, 24 (5.9%) were elderly. Gender, histology, stage, and grade were comparable between the two groups. Despite this apparent similarity, 21% mortality was recorded in individuals >75 yr versus 1.1% in others. Surgical time, blood loss, and transfusion rate were higher in those who died. Among those who survived the surgery, long-term survival was the same. The authors concluded that cytoreductive nephrectomy in the elderly population can be associated with the potential for significant morbidity and mortality. Nonetheless, it provides benefits, central of which is the survival advantage. Therefore, cytoreductive nephrectomies should be performed in elderly patients. However, when they are performed, care should be optimized, perioperative risk should be quantified using physiologic age instead of chronological age, and the expectations of the surgeon and the patient should be realistic.