The world population is ageing and surgical procedures for older patients are associated with higher perioperative morbidity and mortality rates than in younger patients. Segmental ureterectomy (SU) has been proposed as an alternative to radical nephroureterectomy (RNU) for selected upper tract urothelial carcinomas (UTUC), to reduce post-operative morbidity, and preserve renal function. The aim of this study was to compare RNU and SU in terms of post-operative complications, functional outcomes, and overall survival (OS) in older patients treated for UTUC.
Data of patients aged 75 years or older and treated for UTUC were included. The primary outcome was to compare RNU versus SU according to post-operative complications, the estimated glomerular filtration rate (eGFR) variation, and OS. Complications were defined according to the Clavien-Dindo classification. eGFR was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Un-adjusted OS curves were plotted using the Kaplan-Meier method.
Overall, 177 patients (150 RNU and 27 SU) were eligible for the analysis. Pre- and post-operative characteristics were similar between the 2 groups. RNU patients showed higher incidence of post-operative complications (34.0% vs. 7.4%, P = .011). The mean post-operative serum creatinine was lower in SU patients in comparison with the RNU ones (1.23 vs. 1.69 mg/dL, P = .046), but no differences were found in terms of eGFR variation (P = .258). At 3 years of follow-up, the OS was comparable between the two surgical techniques (P = .129).
In older patients diagnosed with UTUC, SU could offer lower rates of post-operative complications without affecting survival.
Clinical genitourinary cancer. 2022 Jan 13 [Epub ahead of print]
Alberto Abrate, Francesco Sessa, Maurizio Sessa, Riccardo Campi, Arcangelo Sebastianelli, Virginia Varca, Carlo Pavone, Marco Vella, Riccardo Bartoletti, Vincenzo Ficarra, Sergio Serni, Eugenio Brunocilla, Andrea Gregori, Carlo Trombetta, Andrea Lissiani, Carlo Terrone, Paolo Gontero, Riccardo Schiavina, Mauro Gacci, Alchiede Simonato
Department of Surgery, Urology Unit, ASST Valtellina e Alto Lario, Sondrio, Italy., Department of Minimally-Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy., Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark., Department of Urology, ASST Rhodense, G. Salvini Hospital, Milan, Italy., Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy., Unit of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy., Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy., Department of Urology, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy., Urology Unit, ASST Fatebenefratelli Sacco, Milan, Italy., Department of Urology, University of Trieste, Trieste, Italy., Department of Urology, IRCCS AOU San Martino, University of Genoa, Genoa, Italy., Division of Urology, Department of Surgical Science, AOU Città della Salute e della Scienza di Torino - Presidio Molinette, University of Turin, Turin, Italy., Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy. Electronic address: .