Outcomes of minimally invasive nephroureterectomy in octogenarians: a single centre experience and review of literature

Introduction: The gold standard treatment for high risk upper tract urothelial cancers is radical nephroureterectomy. Little evidence exists specifically directed for octogenarians with this disease, therefore we highlight our centre's outcomes and compare to current literature. Methods: Demographic, operative and postoperative data were collected on all octogenarian patients who underwent minimally invasive radical nephroureterectomy between 2010 and 2018 in a single centre. Outcomes including intraoperative and postoperative complications, disease recurrence rates and survival data were analysed. A literature search was performed, with six included articles of cases series and retrospective cohort studies after screening of full manuscripts. Results: Twenty-three patients of average age 82.6 years (range 80-85) were included. Length of stay was median 10 days (range 5-53). Six patients (25%) had postoperative complications ranging from Clavien-Dindo classification 2-3. Eight patients were found to have recurrence, with median time to recurrence of 18 months. Of the 13 patients who died during a follow-up of median 38.4 months, five patients (22%) died of disease related to their original diagnosis (median survival 20 months). Conclusions: From this single centre case series results combined with a review of current literature, radical nephroureterectomy is safe for octogenarian patients for upper tract urothelial cancers when appropriately selected. Further work will need to be carried out to assess the role of lymphadenectomy and adjuvant chemotherapy in the older patient cohort.