Laparoscopic radical nephrectomy in the elderly

Objective

As the general population continues to age and the incidence of renal carcinoma continues to increase (1), urologists will be confronted with a greater percentage of elderly patients with disease requiring surgery: although laparoscopic renal procedures have been proposed safe and efficacious in the general population, far less is known about the safety of these procedures in the older population (2). In this study we have evaluated the efficacy and outcome of laparoscopic radical nephrectomy (LRN) in patients aged > 75 years and compared the results with those obtained from patients younger than these undergoing laparoscopic surgery for the same indication.

Methods and results

Patients and methods: From January 2002 to December 2013, 427 patients had laparoscopic nephrectomy for tumour in our department .39 of these 427 were aged > 75 years . Radiological scans available for each patient were noted operative(3). Both groups were compared for several variables before, during and after LRN including the American Society Anesthesiology score, comorbidities and previous surgical history; duration, estimated blood loss, tumour size, intraoperative complications and convertion rates; after surgery the time to oral intake and drain removal, major and minor complications, mortality and hospital stay.
Results: Most patients aged > 75 had more than one comorbidity, the medical problems being largely of cardiovascular origin. Average hospital stay for patients 75 years older was 5.1 days versus 3.4 days for their younger counterparts ( p= 0,01). There was no significant differences between the younger and older groups with regard to mean operative time, EBL, transfusion rate, conversion rate or complication rate.In the elderly group there were an intraoperative complication with a colon injury and 7 postoperative complications ( 4 ileus, 2 acute renal failures and an atelectases. In the younger group there were 3 intraoperative complications ( 1 aorta injury, a colon injury and a renal vein injury) e 21 post operative complications ( 13 ileus, 3 port hernia, 2 atelectasis , 2 acute renal failures and a gastrointestinal bleeding) (4). There was no statistically significant difference in the disease-free survival rate between the elderly and adult groups.

Discussion

Discussion: Our data add to the increasing body of evidence that a patient’s age should not be an exclusionary factor when contemplating laparoscopic surgery and support the safety and feasibility of laparoscopic renal procedures in elderly patients. The overall complication rates and other perioperative parameters appeared compared in our series to those in previously published data (5). Laparoscopic nephrectomy is a reliable approach that allows patients to benefit from the advantages of minimally invasive surgery without increasing the surgical risks.
Conclusions: Elderly patients should not be excluded from undergoing an LRN , even though they usually present with more comorbidities.

References

References:
1. Chow WH, Devesa SS. Contemporary epidemiology of renal cell cancer. Cancer J 2008; 14: 288–301

2.Ljungberg B, Cowan NC, Hanbury DC et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 2010; 58: 398–406

3.Russo P. Renal cell carcinoma: presentation, staging, and surgical treatment. Semin Oncol. 2000 Apr;27(2):160-76.

4.Zhang YS, Li HZ, Ji ZG, Mao QZ, Rong S, Yan WG, Xiao H, Liu GH, Zhang XB, Xu WF. Complications of laparoscopic surgery: a 11-year single institute experience. Beijing Da Xue Xue Bao. 2013 Aug 18;45(4):584-7.

5.Naya Y, Tobe T, Suyama T, Araki K, Komiya A, Suzuki H, Igarashi T, Ichikawa T. The efficacy and safety of laparoscopic nephrectomy in patients with three or more comorbidities. Int J Urol. 2007 Jan;14(1):17-20.