Radical nephrectomy and nephroureterectomy in patients over 80 years old

PURPOSE: The aim of this study was to discover if elderly patients exhibit comparable outcomes and survival benefits to those achieved in younger patients. MATERIALS AND METHODS: We assessed 35 patients over 80 years old treated by radical nephrectomy or nephroureterectomy for malignant and inflammatory conditions within the previous 4 years. A multivariate analysis regarding survival and recovery was conducted and included various preoperative parameters. The subjective opinion of patients or patient's relatives (in cases where the patient had past away) was estimated by answering the following questions: (a) are you satisfied with your decision to undergo the operation? (b) would you undergo it once more if needed? (c) would you advise it to a patient your age? RESULTS: The median age was 83.5 years. Radical nephrectomy with a flank approach was performed in 65.7 percent of cases and nephroureterectomy with a transabdominal approach in 34.3 percent of cases. The median recovery was 13 weeks. During a median follow-up of 31 months (range 12 to 53), 80 percent of patients were disease free. The remaining 20 percent passed away demonstrating a median survival of 25 months (range 13-38). Eighty-eight percent of patients were satisfied with their decision to undergo the operation, 91.4 percent would undergo it once more if needed and 91.4 percent would advise it to a patient their age. CONCLUSIONS: Radical nephrectomy and nephroureterectomy are safe and effective in well-selected patients over 80 years old. Elderly patients exhibit comparable preoperative outcomes and survival benefits to those achieved in younger patients. Various preoperative clinical variables that effect the survival of patients but not their recovery could be identified.

Epidemiología del cáncer de pelvis renal en pacientes del Hospital Nacional Essalud "Guillermo Almenara Irigoyen" Lima - Perú: estudio retrospectivo y descriptivo 1999-2005 / Epidemiology of the renal pelvis cancer in patients of the Guillermo Almenara Irigoyen General Hospital Lima - Perú: retrospective and descriptive study 1999-2005

El cáncer de vía urinaria alta (pelvis renal y/o uréter) es una neoplasia rara. Generalmente es del tipo células de transición. El objetivo de este trabajo es conocer los aspectos epidemiológicos, clínicos y de manejo de los pacientes institucionales con esta patología que han consultado en el Hospital Nacional “Guillermo Almenara Irigoyen”en Lima - Perú. Se revisaron retrospectivamente los ingresos al Servicio de Urología entre los años 1999 al 2005. Se recuperaron 26 ingresos con este diagnóstico. Se analizan sexo, edad, antecedentes clínicos, síntomas, exámenes de laboratorio, tipo histológico, tratamientos, complicaciones y seguimiento. Las edades fluctuaron entre los 47 y 82 años (promedio de 64,8 años). El 53,8 por ciento fueron mujeres. El tabaquismo lamentablemente no se consigna en los ingresos. La hematuria fue el principal síntoma. El 100 por ciento presentaba hematuria en el examen de orina. El 19,2 por ciento estaban con metástasis al momento del diagnóstico. Casi todos los pacientes tuvieron manejo quirúrgico clásico de forma convencional o laparoscópica. El 100 por ciento tenían carcinoma de células transicionales. Las complicaciones perioperatorias fueron mínimas. No se registra mortalidad operatoria. Esta patología es un cáncer poco frecuente, que debe sospecharse ante toda hematuria, que es el principal motivo de consulta. Idealmente el diagnóstico debe ser precoz. Su manejo debe ser esencialmente quirúrgico.

Introduction: Upper urinary tract tumors are infrequent. However when present, they are usually related to transitional cell carcinoma. The purpose of this study was to analyze epidemiologic, clinic and therapeutic aspects of this disease in the Hospital Nacional “Guillermo Almenara Irigoyen” in Lima - Perú. Material and Methods: A Retrospective review of all our admissions between 1999 and 2005 was performed. A total of 26 patients were admitted with this diagnosis. Gender, age, clinical findings, pathology, treatment and follow-up are analyzed.Results: Mean age was 64,8 years (47-82 years), 53,8 percent were women. Tobacco consumption did not appear in the admission data. The chief complaint was hematuria and 100 percent had microscopic hematuria in the lab tests. Almost all the patients underwent surgery (mainly nephroureterectomy with partial cistectomy). All cases had transitional cell cancer. There were minimal complications and no surgical mortality. Conclusions: Carcinoma of the upper urinary tract is infrequent, must be suspected in the event of hematuria. Ideally diagnosis should be preoperative with histological confirmation. Most of the cases are transitional cell cancer, and management must be essentially surgical.