Advanced age is not a prohibitive factor in laparoscopic nephrectomy for renal pathology

Abstract

Since the first procedure by Clayman and colleagues in 1990, laparoscopic nephrectomy has been performed at multiple institutions worldwide and is an accepted approach for benign and malignant renal pathology. We retrospectively compared the outcomes of laparoscopic nephrectomy for renal pathology in patients older than and less than 65 years of age. Data were collected for all patients undergoing elective nephrectomy (simple, radical, and nephroureterectomy) for renal pathology between November 2000 and June 2003. A total of 94 laparoscopic nephrectomies (62 hand-assisted, 32 totally laparoscopic) for renal disease were performed. Indications for surgery included renal cell carcinoma (63), transitional cell carcinoma (7), hypertension (9), chronic pyelonephritis (6), nonfunctioning kidney (4), complex cyst (3), and polycystic kidney disease (2). There were 33 elderly patients (> or = 65 years) and 61 adult patients (< 65 years). The elderly group had a mean operative time (238 min vs 234.3 min; P = 0.89) and blood loss (88.5 mL vs 149.8 mL; P = 0.68) similar to the adult group. Likewise, the incidence of perioperative complications was no different between the two groups (intra-op: 3.0% vs 0%; P = 0.35/post-op: 21.2% vs 16.4%; P = 0.56). The length of hospitalization was longer in the elderly population (5.7 days versus 5.0 days; P = 0.01) compared to the younger adult group. Laparoscopic nephrectomy is well tolerated in the elderly population. For all surgical indications, the use of a minimally invasive approach confers operative times, blood loss, and morbidity that are comparable to those of younger patients. Yet, length of stay remains longer for elderly patients undergoing nephrectomy.