Radical renal surgery (laparoscopic and open) in octogenarians

An ageing population is at significant risk of developing of renal cell carcinoma (RCC). We evaluate our units experience in managing RCC in octogenarians using either laparoscopic or open radical nephrectomy, highlighting the postoperative complication rates and survival outcomes.

From June 2001 to June 2008, 65 octogenarians underwent a radical nephrectomy for suspected renal cell carcinoma. The procedure was performed laparoscopically (group 1) in 29 patients (44%) and via an open nephrectomy (group 2) in 36 patients (56%). The presenting age, sex distribution, ASA score, preoperative co-morbidities and indications for nephrectomy were statically comparable in both groups. Postoperative complications were recorded using the Clavien-Dindo classification.

Both groups were similar preoperatively with respect to age of presentation, ASA score and co-morbidities such as hypertension, ischemic heart disease, and chronic respiratory disease. Group 1 showed better statistically significant operative parameters (operative time and blood loss), mean length of hospital stay and most importantly postoperative complications. Postoperative complication rates were lower in group 1 (48.3%) when compared with group 2 (80.5%) (p<0.05).

Surgery for renal cancer in patient over the age of 80 should only be considered after a thorough work up. Chronological age itself should not be the only determining factor. If such a surgery was to be undertaken, then in our experience, patients who underwent laparoscopic radial nephrectomy had fewer complications than those had open radical nephrectomy.