Lai Frank C, Kau Eric L, Ng Christopher S, Fuchs Gerhard J
Minimally Invasive Urology Institute, Cedars Sinai Medical Center, Los Angeles, California 90048, USA.
J Endourol. 2007 Nov;21(11):1309-13. doi: 10.1089/end.2007.9885.
As life expectancy continues to increase, we will be faced with the need to counsel older patients on the risks and benefits of undergoing surgery. It is clear that laparoscopic renal surgery has significant benefits over open renal surgery. However, contemporary data on whether these benefits carry over to the elderly is less robust. The objective of this study is to compare the perioperative outcomes of laparoscopic nephrectomy in patients age 70 and over to those under age 70. Outcomes from the study can be used to assist in preoperative counseling for older patients.
Between February 2000 and December 2005, 405 consecutive patients underwent laparoscopic nephrectomy for benign or malignant conditions. To decrease selection bias, kidney donors, bilateral nephrectomies, partial nephrectomies, as well as patients under the age of 17 were excluded. Laparoscopic nephrectomies included simple nephrectomies, radical nephrectomies, and nephroureterectomies. A total of 158 patients were included in the analysis. Patient demographics and perioperative data were recorded prospectively. The preoperative American Society of Anesthesiologists (ASA) score was used to reflect patient co-morbidity. Subset analysis between pure laparoscopic nephrectomy (LN) and hand-assisted laparoscopic nephrectomy (HALN) was also performed.
Average hospital stay for patients 70 years and older was 3.6 days versus 2.6 days for their younger counterparts (p = 0.02). All other demographic and perioperative parameters were comparable between groups, including incidence of intraoperative or postoperative complications, blood transfusions, and conversions to open surgery. In a subset analysis of patients undergoing HALN, despite having similar co-morbid conditions (ASA score 2.57 vs. 2.56, p = 0.9), the elderly group had a significantly increased length of stay compared to patients younger than 70 years (3.0 vs. 4.2 days, p < 0.05). However, in the group undergoing LN, there was no statistically significant difference in hospital stay (3.1 vs. 2.4 days, p = 0.22), despite the older group having higher co-morbid conditions (ASA score 2.55 vs. 2.10, p < 0.01).
Other than an increased hospital stay by one day, patients 70 years and older undergoing laparoscopic nephrectomy can expect comparable perioperative outcomes to those achieved in younger patients. Such differences in the length of hospital stay may be mitigated by pure laparoscopic nephrectomy as opposed to hand-assisted laparoscopic nephrectomy in patients 70 years or older. These data may be useful in preoperative decision-making and counseling in this growing subset of patients.
随着预期寿命持续增长，我们将面临为老年患者提供手术风险与益处咨询的需求。显然，腹腔镜肾手术相较于开放性肾手术具有显著优势。然而，关于这些优势是否适用于老年人的当代数据尚不充分。本研究的目的是比较70岁及以上患者与70岁以下患者行腹腔镜肾切除术的围手术期结果。该研究结果可用于协助老年患者的术前咨询。
2000年2月至2005年12月期间，405例连续患者因良性或恶性疾病接受了腹腔镜肾切除术。为减少选择偏倚，排除了肾供体、双侧肾切除术、部分肾切除术以及17岁以下患者。腹腔镜肾切除术包括单纯肾切除术、根治性肾切除术和肾输尿管切除术。共有158例患者纳入分析。前瞻性记录患者的人口统计学和围手术期数据。术前美国麻醉医师协会（ASA）评分用于反映患者的合并症情况。还对单纯腹腔镜肾切除术（LN）和手辅助腹腔镜肾切除术（HALN）进行了亚组分析。
70岁及以上患者的平均住院时间为3.6天，而年轻患者为2.6天（p = 0.02）。两组间所有其他人口统计学和围手术期参数相当，包括术中或术后并发症发生率、输血情况以及转为开放手术的比例。在接受HALN的患者亚组分析中，尽管合并症情况相似（ASA评分2.57对2.56，p = 0.9），但老年组的住院时间相较于70岁以下患者显著延长（3.0天对4.2天，p < 0.05）。然而，在接受LN的组中，住院时间无统计学显著差异（3.1天对2.4天，p = 0.22），尽管老年组的合并症情况更严重（ASA评分2.55对2.10，p < 0.01）。
70岁及以上患者行腹腔镜肾切除术，除住院时间延长一天外，其围手术期结果与年轻患者相当。对于70岁及以上患者，单纯腹腔镜肾切除术相较于手辅助腹腔镜肾切除术，可能会减轻住院时间的差异。这些数据可能有助于这一不断增加的患者亚组的术前决策和咨询。
