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Clinical outcomes following laparoscopic radical nephroureterectomy in octogenarians

Background: This study aimed to compare the incidence of postoperative complications occurring within 30 days of surgery between octogenarians and younger patients and identify preoperative risk factors for the incidence of postoperative complications. Moreover, we also compared the oncological outcomes between octogenarians and younger patients.

Methods: This retrospective study included 283 patients who underwent laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma from 2002 to 2020. The patients were divided into octogenarians and younger patients (age: < 80 years), and their clinical characteristics, perioperative parameters, and postoperative complications were evaluated. The predictors of postoperative complications were evaluated using logistic regression models. Recurrence-free survival, cancer-specific survival, and overall survival were measured using the Kaplan-Meier method.

Results: Twelve (17.1%) octogenarians and 40 (18.7%) younger patients had postoperative complications. No significant difference in the incidence of postoperative complications was observed between octogenarians and younger patients (p = 0.14). A high body mass index was a significant risk factor for complications (p = 0.03). The 5-year recurrence-free survival, cancer-specific survival, and overall survival rates for octogenarians and younger patients were 72% and 64% (p = 0.31), 76% and 63% (p = 0.63), and 43% and 63% (p = 0.06), respectively.

Conclusion: Laparoscopic radical nephroureterectomy can be performed in octogenarians with complication rates similar to those in younger patients. Similarly, the outcomes of laparoscopic radical nephroureterectomy for oncological control do not differ significantly between octogenarians and younger patients. This procedure is safe and effective for selected octogenarians.

Shigeki Koterazawa, Toru Kanno, Go Kobori, Katsuhiro Ito, Hiromichi Nakagawa, Toshifumi Takahashi, Naoto Takaoka, Shinya Somiya, Kanji Nagahama, Masaaki Ito, Yuzuru Megumi, Yoshihito Higashi, Seiji Moroi, Toshiya Akao, Hitoshi Yamada

Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, Japan; Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, Japan. t.kan@kuhp.kyoto-u.ac.jp; Department of Urology, Hamamatsu Rosai Hospital, Hamamatsu, Japan; Department of Urology, Rakuwakai Otowa Hospital, Kyoto, Japan.

Source: Koterazawa S. Clinical outcomes following laparoscopic radical nephroureterectomy in octogenarians. Int J Clin Oncol. 2023. (1):155-162. doi: 10.1007/s10147-022-02269-8.

Read an Expert Commentary by Bishoy Faltas, MD