BERKELEY, CA (UroToday Inc.) - Laparoscopic renal surgery is suggested to provide oncologic equivalency to open renal surgery, yet it also facilitates patient recovery and return to full activity. As such, it is considered by many to be the standard methodology for a variety of indications for nephrectomy.

Data regarding safety of laparoscopic nephrectomy in elderly patients has not previously been compared to a younger cohort. Dr. Ioannis Varkarakis and colleagues at the University of Innsbruck, Austria compared these two age cohorts and reported their findings in BJU International, September 2004.

A retrospective analysis of 33 patients aged > 75 years was compared to 28 consecutive patients <75 years. The patients were studied between 1995 and 2002. Indications for nephrectomy in the older group were ureterolithotomy, simple and radical nephrectomy in two, three and 28 patients, respectively. Standard laparoscopic technique is described. The data was non-randomized and was retrospectively collected by chart review and telephone interviews.

Both groups were compared for several variables before, during and after surgery. These included American Society of Anesthesiology physical status scores (ASA-PS), comorbidities, previous surgical history, operative duration, estimated blood loss, tumor size, intraoperative complications, conversion rates and a variety of variables reflecting recovery time and length of hospital stay.

Mean patient ages were 79.5 and 61.3 years and mean ASA-PS were 2.6 and 1.5 in the older and younger groups, respectively. These were the only two variables to differ by statistical analysis, all other variables being statistically similar. A post-operative myocardial infarction occurred in one elderly patient (9%), while younger patients experienced no post-operative complications. Two patients in the younger cohort had intra-operative complications (colon injury and severe splenic injury), but neither required open surgical conversion.

The authors suggest that their data support equivalent patient safety in older and younger patients undergoing laparoscopic nephrectomy. While they showed evaluation of efficacy, data was not provided for any oncologic outcomes. The study is also limited by its non-randomized, retrospective design and by comparison of surgeries performed over different time periods. Nonetheless, it is the first study to evaluate this question and may help in patient decisions for laparoscopic nephrectomy.

BJU Int. 2004; 94:517-520