Laparoscopic oncological surgery for renal tumors in patients aged 85 years or older

Objective

To analyze our series of radical nephrectomies and laparoscopic nephroureterectomies in elderly patients.

Materials and methods

A retrospective review of patients aged 85 years and older who underwent major laparoscopic surgery for renal tumors at our center between April 2005 and March 2022 was conducted. Clinical-pathological characteristics, complications, and postoperative outcomes were analyzed.

Results

Forty-seven patients were included, with a median age of 87 years. Fifteen nephrectomies for renal tumors (Group 1), and 32 nephroureterectomies for urinary tract tumors, (Group 2) were performed. In Group 1, four postoperative complications were observed: two Clavien 1, one Clavien 2, and one Clavien 4a. The most common histology was clear cell carcinoma. Nine patients had locally advanced tumors (TNM ≥ T3) at diagnosis. Five-year cancer-specific survival and overall survival rates were 73% and 40%, respectively. In Group 2, 14 postoperative complications occurred: six (18.8%) Clavien 1, four (12.5%) Clavien 2, and five (15.6%) Clavien 5. All patients had urothelial carcinoma in their pathology reports. Twenty (62.5%) had invasive tumors (TNM ≥ T2) at diagnosis. Five-year cancer-specific survival and overall survival rates were 45% and 30%, respectively.

Conclusion

Laparoscopic renal oncologic surgery in elderly patients is feasible, although it is associated with a high morbimortality rate, particularly in those with urinary tract tumors. It is essential to provide this patient group with adequate information regarding the elevated surgical risks associated with the procedure.