The study cohort consisted of 70 octogenarian patients and 213 younger patients. The Median follow-up duration was 18 months for the former group and 36.3 months for the latter. Patients in the octogenarian group exhibited lower BMI, a higher proportion of females, and higher American Society of Anesthesiologists (ASA) status. Adjuvant chemotherapy was more commonly administered to younger patients. In addition, younger patients underwent lymph node dissection more frequently The median operative time was significantly shorter, and the median estimated blood loss volume was significantly lower in the octogenarian group.
The incidence of intraoperative or postoperative complications was not significantly different between the two groups. The incidence of grade III or higher complications was similar across the two groups. Complications included wound infection, pneumonia, and peritonitis. Three octogenarians (4.3%) and one younger patient (0.5%) died from postoperative complications. Multivariate logistic regression analyses revealed that high BMI was the only significant risk factor for complications. The 5-year relapse-free survival rates were 72% among octogenarians and 64% among younger patients (non-significant difference). Similarly, there were no significant differences between the two groups for cancer-specific survival and overall survival rates. In a Cox hazards analysis, pathological T stage, pathological N stage, lymphovascular invasion, and margin positivity were significantly associated with poor prognosis.
The findings from this study suggest that LRNU can be performed safely and effectively among octogenarians with UTUC. Overall, age was not associated with significant differences in survival or risk of complications. Limitations of this study include retrospective design and patient selection bias.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
Reference:
- Koterazawa S, Kanno T, Kobori G, et al. Clinical outcomes following laparoscopic radical nephroureterectomy in octogenarians [published online ahead of print, 2022 Nov 21]. Int J Clin Oncol. 2022;10.1007/s10147-022-02269-8. doi:10.1007/s10147-022-02269-8