Introduction and Objectives: Indication for partial nephrectomy depends on tumor size and anatomical complexity, as well as the general condition of the patient. Demographic changes and advanced imaging lead to high numbers of renal tumors detected increasingly in elderly patients. We analyzed perioperative outcomes in an elderly population undergoing retroperitoneoscopic partial nephrectomy (RPN) in a single surgeon series.
Methods: We retrospectively evaluated 160 patients who underwent RPN between 04/2010 and 08/2013. Patients were divided in age groups < 75 years and > 75 years. Age and ASA- score and perioperative parameters such as operation-time, warm ischemia time (WIT), estimated blood loss, complications and length of hospital stay, were analyzed for both groups.
Results: Median age was 66 (31–83) years. 122 (76,25%) and 38 (23,75%) patients were < 75 and > 75 years, respectively. 19 patients were > 80 years. PADUA-score was balanced in both groups. Median ASA-Score was 2,1 and 2,4 in patients < 75 and > 75 years, respectively (p > 0,05). In the group of elderly patients, operating time and blood loss were not different than in the younger group. However, elderly patients had a significant higher complication rate (p < 0,001), longer WIT (p < 0,05) and longer length of hospital stay (p < 0,05). ASA-Score correlated with longer hospital stay (p < 0,05).
Conclusions: Elderly patients have a significant higher risk for postoperative complications than younger patients when undergoing RPN. Elaborate preoperative assessment could minimize the risk of surgery and improve outcome. Prospective evaluation of perioperative parameters in elderly patients may lead to better patient selection for operations, ablative therapies and active surveillance.
Source of Funding: None
|Listen to an interview with Christian Wulfing, one of the authors of this study.|
Presented by Christian Wulfing, Johannes Gockschu, Niclas Flechtenmacher, and David Marghawal at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan
Asklepios Klinik Altona, Department of Urology, Hamburg, Germany