Laparoscopic radical nephrectomy in the elderly

Abstract

Authors from Innsbruck present their work in laparoscopic radical nephrectomy in elderly patients. They evaluated the outcome of this technique in patients over 75 years old and compared the results with a similar number of patients aged less than 75 years who had the same procedure. Despite more comorbid conditions in the older group the final outcome was equally as good as in the younger patients.Hormone‐refractory prostate cancer is becoming a matter of great concern, and authors from Paris describe their experience with a combination of docetaxel and zoledronic acid in this condition. In this early report, they found the use of these agents to be promising, and recommend the setting up of a prospective randomized trial.OBJECTIVETo evaluate the efficacy and outcome of laparoscopic radical nephrectomy (LRN) in patients aged >75 years, and to compare the results with those obtained from patients younger than this undergoing laparoscopic surgery for the same indication.PATIENTS AND METHODSFrom a retrospective review of 33 patients aged >75 years undergoing LRN, 28 were for tumour. A group of 28 consecutive patients aged <75 years undergoing laparoscopy for the same indication were used for comparison. The two groups were compared for American Society of Anesthesiology (ASA) physical status score, comorbidity, previous surgical history, operative duration, estimated blood loss, tumour size, complications during and after surgery, conversion rates, time to oral intake and drain removal, perioperative mortality and hospital stay.RESULTSOnly the initial ASA score was significantly higher for the older patients. All other variables before, during and after surgery were similar for both groups.CONCLUSIONSThe final outcome of laparoscopic surgery in elderly patients was as promising as in their younger counterparts. Therefore, elderly patients should not be excluded from LRN, even though they usually present with more comorbidities.

Nefrectomía radical laparoscópica

“…48 . Dos estudios retrospectivos publicados en 2004 sólo objetivan diferencias en el ASA y en la estancia algo más prolongada 49,50 , pero tampoco diferencias en complicaciones.…”

The efficacy of laparoscopic radical nephrectomy for renal cell cancer in the elderly: An oncological outcome analysis

“…Varkarakis et al evaluated the efficacy and outcome of LRN in 33 patients aged Ն 75 years, and compared the results with those obtained from 28 patients younger than 75 years undergoing laparoscopic surgery for the same indication. 13 Only the American Society Anesthesiologists (ASA) score was significantly higher in older patients. The comorbidity, operative time, blood loss, complications during and after surgery, conversion rate, time to oral intake, perioperative mortality and hospital stay were similar between the two groups.…”

“…[13][14][15] The aim of this study was to compare the perioperative and oncological outcome between the elderly and adult patients who underwent an LRN for renal cell cancer.…”

Is age a prognostic factor for treatment outcome in renal cell cancer—A comprehensive review

“…Tumours not amenable for NSS techniques can be safely treated by radical nephrectomy in the elderly, again either by open or laparoscopic techniques. Peri-operative mortality is low and oncological outcome is comparable with the younger patients provided patients are correctly selected [27,28].…”