Laparoscopic nephrectomy in young-old, old-old, and oldest-old adults

Background, This study reports findings for laparoscopic nephrectomy in com parison with open nephrectomy in ge riatric patients. Methods. Since 1993, a total of 249 patients have undergone nephrectomy for benign disease at the Medical University of Lubeck, Germany. In 11 patient s older than 65 years, a laparoscopic nephrectomy was performed tin the maj ority via a transperitoneal approach), and 42 patients older than 65 years underwent an open-flank nephrectomy. Clinical parameters were evaluated in comparison with both groups and stratified according to age groups. Results. With respect to operative results (operative duration and pre- and postoperative hemoglobin levels), no relevant differences were observed be tween the laparoscopy group and the open-nephrectomy group, even when strat ified according to patient age. However, patients in the laparoscopy group demonstrated a significant advantage concerning blood loss and the number o f required blood transfusions, regardless of age. In addition, patients aft er laparoscopy showed advantages in the postoperative course. Benefits were proven for the analgesic consumption, hospital stay, and convalescence par ameters. Although complication rates were comparable in both groups, an inc rease was observed in both groups for patients aged between 75 and 84 years . Conclusions. Laparoscopic nephrectomy offers comparable operative results ( with reduced blood loss and less need for blood transfusions) when compared with open surgery. Significant advantages can be demonstrated in the posto perative course, and especially geriatric patients benefit from these aspec ts of the minimally invasive approach. Laparoscopy should be regarded as th e primary therapeutic option for nephrectomy for benign disease in these pa tients.