Safety of Laparoscopic Radical Nephrectomy in the Elderly Patients

ABSTRACT

BACKGROUND: Elderly patients with underlying cardiovascular or respiratory diseases are more susceptible to anesthesiologic risks or serious complications following laparoscopic operations. We evaluated the safety of laparoscopic radical nephrectomy in elderly patients to compensate for the lack of Korean data on the subject in the field of urology. METHODS: From March 2003 and March 2009, 73 patients with localized renal cell cancer underwent laparoscopic radical nephrectomy. They were divided into two groups according to age; 75 years or older (elderly group, n=21) and under 75 years (young group, n=52). Operative parameters as well as oncological outcomes were evaluated. RESULTS: The mean age was 77.7+/-2.5 years for the elderly group and 55.9+/-10.5 years for the young group. No significant differences existed between the groups in terms of mean operative time, intraoperative blood loss, complications, and hospital stay. However, American Society of Anesthesiologists (ASA) score, co-morbidities (p<0.05), and rate of transfusion (p<0.05) were significantly higher in the elderly group. In overall analyses, we conclude that in elderly patients undergoing laparoscopic radical nephrectomy, close monitoring of hemoglobin level as well as intraoperative transfusion for maintenance of hemoglobin level at 10 mg/L or higher is necessary in elderly patients to achieve adequate circulation. CONCLUSION: Laparoscopic radical nephrectomy can be considered a safe and effective procedure for most elderly patients.