Psychological distress in patients undergoing surgery for urological cancer. A single centre cross-sectional study

PURPOSE: Interest in the disease-specific psychological well-being of patients with cancer has increased, and it has been estimated that less than half of all patients with cancer are properly identified and subsequently treated for anxiety or depression. The aim of this study is to evaluate psychological distress in uro-oncological patients undergoing different surgeries: radical cystectomy, radical prostatectomy, radical nephrectomy, or transurethral resection (TUR) before the surgery. MATERIALS AND METHODS: We performed a cross-sectional study in consecutively enrolled patients with bladder, kidney, or prostate cancer, scheduled for surgery. Demographic data, socioeconomic status, education level, and diagnoses were recorded. Patients with a previous diagnosis of depression or anxiety were excluded. We evaluated the level of clinically meaningful depression and anxiety assessed by 2 tools: the Hospital Anxiety and Depression Scale (HADS; score ≥8 presence of anxiety and depression; score ≥11 clinical anxiety and depression) and the State-Trait Anxiety Inventory (STAI). To determine variables related to depression and anxiety among the demographic variables, logistic regression analyses were conducted, with P<0.05 considered as statistically significant. RESULTS: A total of 207 patients were recruited, completed the questionnaires and were included in the study. Patients presented a mean age of 70.8 (±10.8) years, 89% were males (n = 184) and 19% of patients presented previous cancer. The majority of patients underwent surgery for bladder tumors (60.4%) and the most common type of surgery was TUR. The most frequent procedures were performed for bladder tumors (60.4%), being TUR the most common type of surgery (52.7%) followed by radical prostatectomy (24.6%). Mean STAI-State score was 19.3 (±10.3), and mean STAI-Trait score was 18.4 (±11.9) points. Clinical levels of anxiety and depression (HADS ≥ 11 points) were found in 19 (9.8%) and 7 (3.6%) cases. And HADS anxiety 8 to 10 points was present in 14.5% (n = 28) and HADS depression 8 to 10 points in 5.7% (n = 11) of the sample, representing presence of psychological distress. Female patients showed a higher level of anxiety and STAI-Trait compared to males. CONCLUSION: The present results show that our patients had lower levels of anxiety and depression than those described in the literature. Sex, tumor type, and surgical approach were significantly related to psychological distress in patients undergoing surgery for urological cancer. Females and patients with kidney tumor and patients undergoing radical nephrectomy presented higher levels of anxiety. Patients with radical cystectomy showed a higher level of STAI-State compared with other surgeries

Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group

Background: Partial nephrectomy (PN) in elderly patients is underutilized with concerns regarding risk of complications and potential for poor outcomes. Objective: To evaluate quality and functional outcomes of PN in patients >75 yr using trifecta as a composite outcome of surgical quality. Design, setting, and participants: Multicenter retrospective analysis of 653 patients aged >75 yr who underwent PN (REnal SURGery in Elderly [RESURGE] Group). Intervention: PN. Outcome measurements and statistical analysis: Primary outcome was achievement of trifecta (negative margin, no major [Clavien 653] urological complications, and 6590% estimated glomerular filtration rate [eGFR] recovery). Secondary outcomes included chronic kidney disease (CKD) stage III and CKD upstaging. Multivariable analysis (MVA) was used to assess variables for achieving trifecta and functional outcomes. Kaplan-Meier survival analysis (KMA) was used to calculate renal functional outcomes. Results and limitations: We analyzed 653 patients (mean age 78.4 yr, median follow-up 33 mo; 382 open, 157 laparoscopic, and 114 robotic). Trifecta rate was 40.4% (n = 264). Trifecta patients had less transfusion (p < 0.001), lower intraoperative (5.3% vs 27%, p < 0.001) and postoperative (25.4% vs 37.8%, p = 0.001) complications, shorter hospital stay (p = 0.045), and lower \u394eGFR (p < 0.001). MVA for predictive factors for trifecta revealed decreasing RENAL nephrometry score (odds ratio [OR] 1.26, 95% confidence interval 1.07\u20131.51, p = 0.007) as being associated with increased likelihood to achieve trifecta. Achievement of trifecta was associated with decreased risk of CKD upstaging (OR 0.47, 95% confidence interval 0.32\u20130.62, p < 0.001). KMA showed that trifecta patients had improved 5-yr freedom from CKD stage 3 (93.5% vs 57.7%, p < 0.001) and CKD upstaging (84.3% vs 8.2%, p < 0.001). Limitations include retrospective design. Conclusions: PN in elderly patients can be performed with acceptable quality outcomes. Trifecta was associated with decreased tumor complexity and improved functional preservation. Patient summary: We looked at quality outcomes after partial nephrectomy in elderly patients. Acceptable quality outcomes were achieved, measured by a composite outcome called trifecta, whose achievement was associated with improved kidney functional preservation. Partial nephrectomy in elderly patients provides quality outcomes as measured by trifecta. Tumor complexity is a key determinant for trifecta achievement, and trifecta attainment is associated with improved function. Increasing utilization of robotics has benefits in recovery without compromising quality

Outcomes of Partial and Radical Nephrectomy in Octogenarians – A Multicenter International Study (Resurge)

To analyze the outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) in octogenarian patients

Partial versus radical nephrectomy in very elderly patients: a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project)

PURPOSE: To compare the outcomes of PN to those of RN in very elderly patients treated for clinically localized renal tumor. PATIENTS AND METHODS: A purpose-built multi-institutional international database (RESURGE project) was used for this retrospective analysis. Patients over 75 years old and surgically treated for a suspicious of localized renal with either PN or RN were included in this database. Surgical, renal function and oncological outcomes were analyzed. Propensity scores for the predicted probability to receive PN in each patient were estimated by logistic regression models. Cox proportional hazard models were estimated to determine the relative change in hazard associated with PN vs RN on overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM). RESULTS: A total of 613 patients who underwent RN were successfully matched with 613 controls who underwent PN. Higher overall complication rate was recorded in the PN group (33% vs 25%; p\u2009=\u20090.01). Median follow-up for the entire cohort was 35 months (interquartile range [IQR] 13-63 months). There was a significant difference between RN and PN in median decline of eGFR (39% vs 17%; p\u2009<\u20090.01). PN was not correlated with OM (HR\u2009=\u20090.71; p\u2009=\u20090.56), OCM (HR\u2009=\u20090.74; p\u2009=\u20090.5), and showed a protective trend for CSM (HR\u2009=\u20090.19; p\u2009=\u20090.05). PN was found to be a protective factor for surgical CKD (HR\u2009=\u20090.28; p\u2009<\u20090.01) and worsening of eGFR in patients with baseline CKD. Retrospective design represents a limitation of this analysis. CONCLUSIONS: Adoption of PN in very elderly patients with localized renal tumor does not compromise oncological outcomes, and it allows better functional preservation at mid-term (3-year) follow-up, relative to RN. Whether this functional benefit translates into a survival benefit remains to be determined