Cancer renal en ancianos

Renal cancer surgery in the elderly
¨ Frederik C. Roos, Christian Hampel and Joachim W. Thuroff
Department of Urology, Johannes Gutenberg University, Medical School, Mainz, Germany Correspondence to Joachim W. Thuroff, MD, ¨ Department of Urology and Pediatric Urology, Johannes Gutenberg University, Langenbeckstrasse 1, 55101 Mainz, Germany Tel: +49 6131 177183; fax: +49 6131 176415; e-mail:thueroff@urologie.klinik.uni-mainz.de Current Opinion in Urology 2009, 19:459–464

Purpose of review Renal cell carcinoma mainly develops in the sixth or seventh decade of life. As life expectancy increases, urologists have to deal with elderly patients presenting with renal cancer. The introduction of ablative techniques has even widened our armamentarium of treating elderly patients with renalcancer apart from the standard laparoscopic and open surgical procedures. Our review highlights the current literature focusing on the functional and oncological outcome of surgically treated renal cancer in elderly patients. Recent findings Despite the higher percentage of comorbidities, perioperative morbidity and declined renal reserve in elderly patients, radical or partial nephrectomy beingperformed open or laparoscopically for localized disease offers excellent functional and oncological outcome in this age group. Elderly patients seem to benefit more from laparoscopic procedures with lower rates of perioperative morbidity and faster convalescence compared with the open approach. Ablative techniques performed percutanousely may be promising for small renal masses in the future.Summary Surgical treatment of renal cancer performed laparoscopically or open is feasible and well tolerated in elderly patients, with low perioperative morbidity and a good overall survival rate. Long-term results for ablative techniques are still missing for this age group. Patients should be carefully selected for one of the surgical treatments according to their health, fitness, wishes and theexperience of the referred centre. Keywords complications, elderly, oncological and functional outcome, renal cell carcinoma, surgical treatment
Curr Opin Urol 19:459–464 ß 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 0963-0643

Introduction
As a result of a steadily increasing life expectancy, more elderly patients are being treated with surgery [1]; the incidence and mortalityrates of kidney cancer have also been rising at the same time [2,3]. Renal cell carcinoma (RCC) is mainly a disease of the sixth and seventh decades of life [4,5], with the highest reported incidence of approximately 56 of 100 000 in patients aged 75–84 years [6]. The only potentially curative therapy for localized RCC remains the surgical excision [5]. Meanwhile, elderly patients more often seeksurgery for treating their renal tumours, either by laparoscopic or open techniques [6–8].

A recent Surveillance, Epidemiology, and End Results (SEER) database analysis (1983–2002) [9] comprised 26 616 patients with surgically treated renal cancer for localized disease, which showed that the benefits of surgical treatment are lowest among older patients (e.g. age 70 years, n ¼ 1340) with renalmasses of 4 cm or less in size (17.3%). However, 82.7% of the patients in this study presented with renal cancer tumours of more than 4 cm. Whereas, surveillance appears to be a viable option for infirm patients aged at least 80 years with small (median 2.5 cm) slow growing (0.28 cm/year) tumours [10], limited information is available about the feasibility and safety of ablative procedure suchas cryoablation or radiofrequency ablation (RFA) in this age group with increased perioperative morbidity [11]. Little is known about the benefits or the outcome of elderly patients undergoing surgical treatment for their renal cancer. Our review emphasizes on the surgical treatment of renal cancers in elderly patients (aged
DOI:10.1097/MOU.0b013e32832f0c7d

Surgical challenges in elderly
The...