Effective Treatment of Upper Urinary Tract Malignancies Using Laparoscopic Surgery in Three Nonagenarians in Poor General Condition: Are They Too Old for Surgery?

Surgical procedures in the elderly are associated with higher perioperative morbidity and mortality rates than in younger patients. This is especially significant because elderly individuals are more likely to be operated on now than in the past because they represent the fastest growing subset of the population in advanced countries. Our cases are three nonagenarian patients with renal malignancy in poor general condition and were effectively treated by laparoscopic surgery. Case 1 was a 91-year-old male patient with a right renal cell carcinoma of pT1b N0 M0. Case 2 was a 92-year-old male patient with a right renal pelvic tumor of pT3 N0 M0. Case 3 was a 90-year-old female patient with a left renal pelvic tumor of pT2 N0 M0. Case 1 had an Eastern Cooperative Oncology Group performance status of 1. The status of cases 2 and 3 was both rated as 2. All three cases had grade 3A chronic kidney disease. Cases 2 and 3 also had deep vein thrombosis in the lower extremities and dementia. In addition, case 2 had coronary occlusive disease. All cases were treated by laparoscopic surgery and effectively discharged from hospital without major physical complications. This report is the first English-language article that describes treating nonagenarian patients by laparoscopic urologic surgery. An increasing number of nonagenarian patients present with urologic malignancies, and surgeons are frequently faced with the question, "Are they too old for surgery?" Our report suggests that laparoscopic surgery for renal malignancy in nonagenarian patients is feasible.