高齢者における腹腔鏡下腎手術の検討

Abstract

It is clear that laparoscopic renal surgery has significant advantages over open renal surgery. However, current data on whether these benefits carry over to the elderly are less robust. The objective of this study was to compare the perioperative parameters of laparoscopic nephrectomy and nephroureterectomy in patients aged 70 and over versus those under 70 years of age. The new scoring system, the “E-PASS” (estimation of physiologic ability and surgical stress) was also studied. This scoring system predicts the postsurgical risk by quantifying the patient’s reserve and surgical stress. E-PASS comprises the perioperative risk score (PRS), the surgical stess score (SSS), and the comprehensive risk score (CRS) that is determined using the other two scores. Between January 2006 and December 2009, a total of 55 patients who underwent laparoscopic renal surgery met the study inclusion criteria. The perioperative parameters were comparable in the younger patients and the older patients, including SSS, the postoperative complication rate, the operation time and the hospital stay. Laparoscopic renal surgery is feasible and well tolerated in elderly patients, with a low perioperative morbidity and surgical stress. Further examination on the E-PASS scoring system for application to urologic surgery was considered to be necessary. Age alone should not exclude elderly patients from definitive treatment at the outset.