Radical nephrectomy and nephroureterectomy in the octogenarian and nonagenarian: Comparison of laparoscopic and open approaches

Objectives, To retrospectively compare the outcome of laparoscopic and open radical nephrectomy or nephroureterectomy in patients 80 years old or olde r, inasmuch as the tolerance profile of major laparoscopic renal surgery in comparison to open surgery in the elderly patient has not been previously reported. Methods. Since September 1997, 11 patients 80 years old or older underwent retroperitoneal laparoscopic radical nephrectomy or nephroureterectomy for cancer. These patients were compared with 6 consecutive patients 80 years o ld or older who underwent comparable open surgery at our institution since January 1994. No tumor had computed tomographic evidence of lymphatic, vasc ular, or perirenal extension. Results. Baseline parameters were comparable between the laparoscopic and o pen groups. The laparoscopic group had a similar median surgical time (210 minutes versus 175 minutes; P = 0.1) and blood loss (150 mL versus 125 mL; P = 0.8) compared with the open group. However, specimen weight was larger in the laparoscopic group (568 g versus 292 g; P = 0.04). Moreover, the lap aroscopic group had a quicker resumption of oral intake (less than 1 day ve rsus 4 days; P <0.001), decreased narcotic requirements (14 mg versus 526 m g; P = 0.004), shorter hospital stay (2 days versus 6 days; P <0.001), and faster convalescence (14 days versus 42 days; P <0.001) compared with the o pen group. Conclusions. Retroperitoneal laparoscopic radical nephrectomy and nephroure terectomy are well tolerated by the elderly patient. Although our sample si ze was small, it appears that laparoscopy is an excellent alternative to op en surgery for excision of selected renal malignancies in the octogenarian and nonagenarian population. UROLOGY 53: 1121-1125, 1999. (C) 1999, Elsevie r Science Inc. All rights reserved.