Radical Nephroureterectomy in the Very Elderly: A Single-Center Experience of Patients Aged ≥85 Years

The incidence of upper tract urothelial carcinoma is increasing with population aging, yet evidence regarding radical nephroureterectomy (RNU) in very elderly patients is limited. This study evaluated perioperative outcomes, complications, and oncological results of RNU in patients aged ≥85 years compared with younger counterparts.

A total of 305 patients who underwent RNU between April 2003 and December 2024 at a tertiary institution were retrospectively reviewed. After excluding those with incomplete data (n = 4), non-urothelial histology (n = 8), or undeterminable pathology (n = 9), 284 patients were eligible. Group A included 24 patients aged ≥85 years, range 85-94 years, and group B included 260 patients <85 years, range 46-84 years. Clinicopathological features, operative outcomes, complications, and survival were compared. Temporal trends and restricted mean survival time (RMST) analyses were also performed.

Baseline characteristics were similar (all P > .05). Median laparoscopic operative time was shorter in group A (206 vs. 235 minutes, P = .029). Estimated blood loss, transfusion, and complication rates (10.6% overall; major 2.2%) did not differ (all P > .05). Pathological outcomes were comparable (all P > .05). Adjuvant therapy was less frequent in group A (0% vs. 21.2%, P = .006). Follow-up was 16.3 vs. 35.2, with no differences in survival (all P > .05). The RMST showed shorter survival in group A.

The RNU appears feasible in carefully selected patients aged ≥85 years, with perioperative and oncological outcomes broadly comparable to those of younger patients. Chronological age alone should not contraindicate surgery. Restricted mean survival time offers complementary insights into survival estimation in this high-risk population. Cite this article as: Gozu S, Yajima S, Okumura G, et al. Radical nephroureterectomy in the very elderly: A single-center experience of patients aged ≥85 years. Urol Res Pract. 2026, 52, 0125, doi: 10.5152/tud.2026.25125.