Robot-assisted partial nephrectomy for localized renal masses in elderly and younger patients: a systematic review and meta-analysis of perioperative outcomes.

Abstract

Purpose: Robot-assisted partial nephrectomy (RAPN) is an established treatment modality for localized renal masses (LRMs). Nevertheless, its applicability in aging populations presents unique challenges, with limited existing evidence. This meta-analysis aims to evaluate the safety and feasibility of RAPN for LRMs in elderly patients compared to younger individuals.

Methods: Databases were searched until August 2024 to identify articles comparing RAPN outcomes in elderly and younger patients. Studies were stratified based on age cutoffs for older individuals. Three primary cutoffs were employed for subgroup analysis: 70-74, 75-79, and ≥ 80 years old. Primary outcomes included the incidence of any grade and major complications (Clavien-Dindo ≥ 3) and trifecta achievement. Odds ratios (OR) and mean differences (MD) were used for statistical comparisons.

Results: Seven studies comprising 5,937 patients were included. A significantly higher incidence of any grade complications was observed in elderly patients (OR 1.38 [95%confidence interval [CI] 1.03, 1.84], p = 0.02). However, there was no difference in major complications (OR 1.32 [95%CI 0.79, 2.18], p = 0.28) or trifecta achievement (OR 1.02 [95%CI 0.83, 1.25], p = 0.84) between elderly and younger patients. Similarly, estimated blood loss, transfusion rates, positive surgical margins, and operative time were comparable between groups. Notably, elderly individuals had a shorter warm ischemia time (MD -1.59 [95%CI -2.40, -0.79], p < 0.001).

Conclusions: RAPN appears to be a viable treatment option for well-selected elderly patients with LRMs who are candidates for active treatment. While elderly patients experienced higher rates of minor complications, major complications and trifecta achievement were comparable to those of younger patients.