[The place of laparoscopic nephrectomy in the elderly subject]

The concomitant increase in life expectancy and the incidence of kidney cancers will result in an increase in kidney cancers in subjects over 75 years of age in the coming years. A wait-and-see attitude in cases of voluminous tumors, particularly symptomatic tumors, may well alter the quality of life of these patients through chronic abdominal pain, macroscopic hematuria, or alteration of the general condition due to metastatic progression. Curative or palliative surgical management can be envisioned and should be discussed in the multidisciplinary consensus meeting. Before validating the indication for nephrectomy in the elderly patient, a preoperative geriatric assessment should be made. Moreover, preoperative renal function should be carefully evaluated to measure the risk of terminal renal failure. The reduction in the mean duration of the hospital stay provided by laparoscopic surgery allows patients to return home or to their institution more quickly, an important consideration in the rehabilitation of these patients, who are very sensitive to such changes. Laparoscopic nephrectomy, with evidence in the literature of reduced morbidity and satisfactory oncological results, could therefore be superior to open surgery when indicated and technically feasible.