title: Laparoscopy extirpative renal surgery in the octogenarian population.
abstract: OBJECTIVE
  Laparoscopic extirpative surgery for cancer is usually safe and effective, even in the elderly. However, the risk to benefit ratio of laparoscopic nephrectomies in patients aged over 80 has not been quantified objectively. The purpose of this study is to analyze the outcomes of this technique in the octogenarian population.
  
  
  METHODS
  Between July 2001 and March 2008, 37 laparoscopic nephrectomies were performed for malignancy in patients over the age of 80. Patient demographics and perioperative and postoperative data were analyzed retrospectively.
  
  
  RESULTS
  Population characteristics include a median age of 82, 65% female with a median American Society of Anesthesiologists score of 2. In all, 57% of the laparoscopic nephrectomies were left sided. Twenty-four laparoscopic nephrectomies were for renal cell carcinoma, with 13 nephroureterectomies for transitional cell carcinoma. A total of 32% had postoperative complications, three of which resulted in death. Average total length of hospital stay was 10.5 days. Stage of malignancy varied from pT(a) to pT(4), and the mean size of the specimen was 169 x 77 mm with a mean tumor size of 54 x 44 mm. At 1 year follow-up (n = 27), 85% were alive, and at 3 years (n = 21) 52% were alive and free of disease.
  
  
  CONCLUSIONS
  Our small study suggests that laparoscopic nephrectomy in this age group is feasible, although the results are far from ideal. Cancer-specific survival rates are poor in this population, and therefore the risk to benefit ratio should be weighed up carefully prior to committing a patient in this age group to extirpative surgery.
authors.affiliation: Department of Urology, St. George's Hospital, London, United Kingdom. danmagrill@hotmail.com
authors.forename: Dan
authors.initials: D
authors.lastname: Magrill
authors.forename: Tet
authors.initials: T
authors.lastname: Yap
authors.forename: Jordan
authors.initials: J
authors.lastname: Durrant
authors.forename: Christopher
authors.initials: C
authors.lastname: Anderson
authors.forename: Peter
authors.initials: P
authors.lastname: Rimington
authors.forename: Abhay
authors.initials: A
authors.lastname: Rane
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007668:Kidney / Q000601:surgery*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D009367:Neoplasm Staging; D011300:Preoperative Care