Laparoscopic renal surgery in the octogenarian

Associate Editor Ash Tewari Editorial Board Ralph Clayman, USA Inderbir Gill, USA Roger Kirby, UK Mani Menon, USA

OBJECTIVE

To describe our experience with laparoscopic renal surgery (LRS) in the octogenarian. Octogenarians are generally suboptimal surgical candidates but the recent upsurge of minimally invasive options for the management of kidney lesions, such as laparoscopic excision, cryoablation and radiofrequency ablation (RFA), have changed that perception.

PATIENTS AND METHODS

In all, 26 patients aged ≥80 years underwent LRS at Brown University and the University of Wisconsin between 2000 and 2006. Demographic information, anatomical location, tumour stage, comorbidities, type of laparoscopic approach, management and outcomes were assessed. Complications during and after LRS, hospital stay, analgesia requirements and return to normal activity were analysed.

RESULT

The mean age of the patients was 81 years. The procedures performed included hand‐assisted laparoscopic partial nephrectomy (three patients), hand‐assisted laparoscopic radical nephrectomy (10), hand‐assisted laparoscopic nephroureterectomy (four), laparoscopic‐assisted cryoablation (seven), laparoscopic RFA (one), and laparoscopic unroofing of a renal cyst (one). The mean (range) follow‐up was 40 (8–84) months. The mean American Society of Anesthesiologists score was 2.5. The average hospital stay was 5.6 days and the mean time to normal activity after discharge was 19 days. There were two major and five minor complications. Nineteen of 22 patients evaluable had no evidence of disease at the last follow‐up. The three deceased patients died of unrelated causes.

CONCLUSION

LRS in the octogenarian is safe to perform in patients with multiple comorbidities. The major and minor complication rates were 7% and 19%, respectively. Recent trends show that ablative procedures are being performed more commonly than surgical excision in this age group.