Thomas Anil A, Aron Monish, Hernandez Adrian V, Lane Brian R, Gill Inderbir S
Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Urology. 2009 Nov;74(5):1042-6. doi: 10.1016/j.urology.2009.04.099. Epub 2009 Aug 15.
To assess the safety and technical feasibility of laparoscopic partial nephrectomy in patients aged >or=80 years at our institution to determine whether this treatment modality may be justifiable in select octogenarians. As the US population ages, an increasing number of elderly patients with renal masses are considered for partial nephrectomy. We present our experience with laparoscopic partial nephrectomy in octogenarians to determine the safety and technical feasibility of this procedure in an elderly population.
Between 1999 and 2007, we reviewed 832 patients who underwent laparoscopic partial nephrectomy for renal tumors at our institution. Demographics, perioperative data, and renal function of patients aged >or=80 years were compared with younger patients.
A total of 791 patients aged <80 years (median 59, range 17-79) and 41 patients aged >or=80 years (median 82, range 80-88) underwent laparoscopic partial nephrectomy. In comparison with patients aged <80 years, octogenarians had higher overall American Society of Anesthesiology (P = .002) and Charlson Comorbidity Scores (P = .006) with an increased incidence of chronic kidney disease (P = .008); however, intraoperative and postoperative complications were similar between the groups (P = .3, P = .5). Despite a lower preoperative glomerular filtration rate in the octogenarian group (median 68 vs 82, P <.0001), the overall decline in glomerular filtration rate between age groups was not significantly different (P = .7).
Laparoscopic partial nephrectomy can be performed safely in appropriately selected patients aged >or=80 years, with rates of perioperative morbidity similar to those observed in younger patients. On the basis of our data, age alone should not be a contraindication to laparoscopic partial nephrectomy.
评估在我院年龄≥80岁的患者中进行腹腔镜下部分肾切除术的安全性和技术可行性，以确定这种治疗方式在特定的八旬老人中是否合理。随着美国人口老龄化，越来越多患有肾肿块的老年患者被考虑进行部分肾切除术。我们介绍我们在八旬老人中进行腹腔镜下部分肾切除术的经验，以确定该手术在老年人群中的安全性和技术可行性。
1999年至2007年期间，我们回顾了在我院接受腹腔镜下部分肾切除术治疗肾肿瘤的832例患者。将年龄≥80岁患者的人口统计学、围手术期数据和肾功能与年轻患者进行比较。
共有791例年龄<80岁（中位年龄59岁，范围17 - 79岁）和41例年龄≥80岁（中位年龄82岁，范围80 - 88岁）的患者接受了腹腔镜下部分肾切除术。与年龄<80岁的患者相比，八旬老人的美国麻醉医师协会总体评分更高（P = 0.002），查尔森合并症评分更高（P = 0.006），慢性肾病的发生率更高（P = 0.008）；然而，两组之间的术中和术后并发症相似（P = 0.3，P = 0.5）。尽管八旬老人组术前肾小球滤过率较低（中位值68对82，P <0.0001），但各年龄组之间肾小球滤过率的总体下降没有显著差异（P = 0.7）。
在适当选择的年龄≥80岁的患者中，可以安全地进行腹腔镜下部分肾切除术，围手术期发病率与年轻患者相似。根据我们的数据，仅年龄不应成为腹腔镜下部分肾切除术的禁忌证。
