Laparoscopic partial nephrectomy in octogenarians

Abstract

Objectives: To assess the safety and technical feasibility of laparoscopic partial nephrectomy in patients aged >or=80 years at our institution to determine whether this treatment modality may be justifiable in select octogenarians. As the US population ages, an increasing number of elderly patients with renal masses are considered for partial nephrectomy. We present our experience with laparoscopic partial nephrectomy in octogenarians to determine the safety and technical feasibility of this procedure in an elderly population.

Methods: Between 1999 and 2007, we reviewed 832 patients who underwent laparoscopic partial nephrectomy for renal tumors at our institution. Demographics, perioperative data, and renal function of patients aged >or=80 years were compared with younger patients.

Results: A total of 791 patients aged <80 years (median 59, range 17-79) and 41 patients aged >or=80 years (median 82, range 80-88) underwent laparoscopic partial nephrectomy. In comparison with patients aged <80 years, octogenarians had higher overall American Society of Anesthesiology (P = .002) and Charlson Comorbidity Scores (P = .006) with an increased incidence of chronic kidney disease (P = .008); however, intraoperative and postoperative complications were similar between the groups (P = .3, P = .5). Despite a lower preoperative glomerular filtration rate in the octogenarian group (median 68 vs 82, P <.0001), the overall decline in glomerular filtration rate between age groups was not significantly different (P = .7).

Conclusions: Laparoscopic partial nephrectomy can be performed safely in appropriately selected patients aged >or=80 years, with rates of perioperative morbidity similar to those observed in younger patients. On the basis of our data, age alone should not be a contraindication to laparoscopic partial nephrectomy.