[Laparoscopic nephrectomy in geriatric patients: comparison with conventional nephrectomy].
BACKGROUND
We report our experience with laparoscopic nephrectomy in comparison to open nephrectomy in geriatric patients. The laparoscopic technique is presented and the results are discussed with respect to the data from the current literature.


METHODS
Since 1993, a total of 249 patient have undergone a nephrectomy for benign renal disease. In 131 patients a laparoscopic nephrectomy (in most cases via a transperitoneal approach) was performed and in 118 patients an open nephrectomy via a flank incision. Clinical parameters were compared between both groups as well as with respect to different age groups.


RESULTS
There were no differences in terms of operative results (operative time, pre- and postoperative hemoglobin) between the laparoscopy group and open nephrectomy group as well as among the different age groups. Patients in the laparoscopy group demonstrated significant advantages with respect to blood loss, transfusion rate, analgesic consumption, hospital stay, and convalescence. These advantages were not related to patient age. The complication rate was comparable for both groups; however, both groups showed an elevation of the complication rate in the age groups 75 to 84 years. The mortality rate within the first 30 days after nephrectomy was 1.7% in the open nephrectomy group.


CONCLUSIONS
The laparoscopic nephrectomy offers comparable operative results (with less blood loss and a lower transfusion rate) when compared to open nephrectomy. In terms of postoperative parameters, patients in the laparoscopy group have significant advantages. Especially geriatric patients benefit from these advantages and, therefore, the laparoscopic approach should be the preferred technique for a nephrectomy in these patients.
Fornara
P
P
Klinik und Poliklinik für Urologie Universitätsklinikum Lübeck Ratzeburger Allee 160 D-23538 Lübeck.
Doehn
C
C
Jocham
D
D
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality / Q000601:surgery*; D010535:Laparoscopy; D009392:Nephrectomy; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D015996:Survival Rate