Complications of urologic laparoscopic surgery in the elderly. Preliminary report
Keywords:
OLDER ADULT, LAPAROSCOPIC SURGERY, COMORBIDITY, COMPLICATIONS, SURGICAL RISK.Abstract
Introduction: the benefit of urological laparoscopic surgery in the elderly is controversial due to the complications attributed to it.
Objective: to describe the complications of the laparoscopic approach in urological entities in the elderly.
Methods: descriptive, retrospective, cross-sectional study in 185 patients ≥60 years old operated by urological laparoscopic surgery at the National Center for Minimal Access Surgery, January 2010-June 2021. Descriptive statistics, Chi-square and Student's t (p≤0,05) were used, age and other variables were associated with the occurrence of complications.
Results: 32 patients were complicated (17,30 %), the mean age was 68.6 years, in the groups between 60-69 and 70-79 years were complicated more frequently (p=0,37), not so with the longest-lived (≥80 years). Most of the complicated patients were ASA-2 (11,3 %) and this variable was significantly associated (p=0,004); they had some comorbidity (14,6 %), among those complicated 11,9 % received highly complex surgery and 12,4 % required prolonged surgical times, p=0,32; p=0,002; p=0,036, respectively. The predominant intraoperative complication was bleeding (Satava II-2,7 %), associated with partial nephrectomy; the most frequent postoperative complications were infection (8,1 %) and bleeding (5,1 %), classified Clavien Dindo II, IIIb, IVa-IVb, IVb, respectively.
Conclusions: laparoscopic urologic surgery in elderly patients is safe. Complications are usually of low severity, related to increased ASA, operative time and complexity of surgery.
Downloads
References
1. Lowrance WL, Yee DS, Savage C, Cronin AM, OBrien MF, Machele D. Complications after radical and parthial nephrectomy as function of age. J urol [Internet]. 2019 [citado 15/05/2022]; 9(6): e98950. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179201/
2. Bombaci E. Factors affecting hospital stay in patients aged 65 years who underwent laparoscopy urological intervention: A single-center retrospective study. Urol Sci [Internet]. 2020 [citado 05/06/2023]; 31(1): 28-35. Disponible en: https://journals.lww.com/ursc/fulltext/2020/31010/factors_affecting_hospital_stay_in_patients_aged.7.aspx
3. Sirithanaphol W, Pachirat K, Rompsaithong U, Kiatsopit P, Ungareevittaya P, Chindaprasirt J. Perioperative outcomes in elderly patients undergoing nephrectomy for renal cell carcinoma. Res Rep Urol [Internet]. 2019 [citado 17/12/2021]; 11: 195-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31440483 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664253/
4. Cuba, Ministerio de Salud Pública, Dirección de Registros Médicos y Estadísitcas de Salud. Población media y densidad de población según grupo de edad y provincia. Anuario Estadístico de Salud 2021 [Internet]. La Habana; 2022 [citado 21/06/2023]; 18. Disponible en: https://files.sld.cu/bvscuba/files/2022/08/Anuario-Estadistico-Espa%c3%b1ol-2022-Definitivo.pdf.
5. Yanagihara Y, Nishida K, Watanabe R, Koyama K, Sawada Y, Noda T, et al. Feasibility of Laparoscopic Radical Cystectomy in Elderly Patients: A Comparative Analysis of Clinical Outcomes in a Single Institution. Acta med Okayama [Internet]. 2019 [citado 04/01/2022]; 73(5): 417-8. Disponible en: https://ousar.lib.okayama-u.ac.jp/files/public/5/57371/20191021173206642562/73_5_413.pdf
6. Akkoç A, Aydın C. How safe and effective is laparoscopic decortication of simple renal cysts in elderly patients? The Aging Male [Internet]. 2020 [citado 05/06/2023]; 23(3): 227-31. Disponible en: https://doi.org/10.1080/13685538.2020.1741542
7. Wunderle MF, Härtel N, Wagener N, Kowalewski KF, Nuhn P, Walach MT, et al. Prospective geriatric assessment for perioperative risk stratification in partial nephrectomy. Eur J Surg Oncol [Internet]. 2021 [citado 17/12/2021]; 47(4): 913-9. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0748-7983(20)30878-7
8. Territo A, Di Buono G, Buscemi S, Mantica G, Falco V, Palacios VH, et al. Evaluation of predictive factors for i-CLARAS (intraoperative complications in laparoscopic renal and adrenal surgery): a multicentre international retrospective cohort study. Scientific reports [Internet]. 2024 [citado 02/02/2024]; 14(1): 1372. Disponible en: https://doi.org/10.1038/s41598-024-51696-2
9. Cao L, Yang Z, Qi L, Chen M. Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: A Systematic review and meta-analysis. Medicine (Baltimore) [Internet]. 2019 [citado 13/01/2022]; 98(22): e15770-e. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31145297
10. Campos-Sañudo JA, Ballestero-Diego R, Zubillaga-Guerrero S, Rodríguez-Sanjuán JC, Asensio-Lahoz A, Monge-Miralles JM, et al. Complications and mortality after radical nephrectomy in a low-volume hospital. Arch Esp Urol [Internet]. 2019 [citado 15/12/2022]; 72(7): 653-61. Disponible en: https://www.aeurologia.com/EN/Y2019/V72/I7/653
11. Ingels A, Duc S, Bensalah K, Bigot P, Paparel P, Beauval JB, et al. Postoperative outcomes of elderly patients undergoing partial nephrectomy. Scientific reports [Internet]. 2021 [citado 20/06/2022]; 11(1): 17201. Disponible en: https://doi.org/10.1038/s41598-021-96676-y
12. Geiger S, Kocher N, Illinsky D, Xylinas E, Chang P, Dewey L, et al. Comparison of the Comprehensive Complication Index and Clavien-Dindo systems in predicting perioperative outcomes following radical nephroureterectomy. Transl Androl Urol [Internet]. 2020 [citado 15/12/2022]; 9(4):1780-5. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32944540/
13. Yoshino T, Oshima S, Sugitani T, Kobayashi Y, Kawakami K, Kodama K, et al. Impact of visceral obesity on operative outcomes of laparoscopic nephrectomy: comparison between visceral fat area and body mass index. African Journal of Urology [Internet]. 2021 [citado 23/07/2022]; 27(1): 65. Disponible en: https://doi.org/10.1186/s12301-021-00164-8
14. Arfi Nicolas, Bldini A, Petrucci M, Ecochard R, Ruffion A, Paparel P. Impacto de la obesidad en las complicaciones de la nefrectomía laparoscópica simple o radical. Curr Urol [Internet]. 2022 [citado 25/11/2022]; 8(3): 149-55. Disponible en: https://10.1159/000365707
15. Gu P, Li M, Zhang M, He X. Effect of body mass index on the operation time and postoperative hospital stay of retroperitoneal laparoscopic renal cyst decortication. Laparoscopic, Endoscopic and Robotic Surgery [Internet]. 2021 [citado 15/05/2022]; 4(2): 40-3. Disponible en: https://www.sciencedirect.com/science/article/pii/S2468900921000207.
16. Song P. Frailty and elderly in urology: implications for postoperative complications. Yeungnam Univ J Med [Internet]. 2020 [citado 17/12/2021]; 37(4):296-301. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606957/.
17. Guo J, Zeng Z, Cao R, Hu J. Intraoperative serious complications of laparoscopic urological surgeries: a single institute experience of 4,380 procedures. Int braz j urol [Internet]. 2019 [citado 15/12/2022]; 45(4): 739-46. Disponible en: https://www.scielo.br/j/ibju/a/g8DMR5VdR8V4NwpxRzmkDbj/?lang=en
18. Guo Y, Xu Q, Chen B, Liu L, Wang Y, Zhu A, et al. Clinical outcomes and effect on intraoperative blood loss and postoperative pain of patients undergoing retroperitoneal laparoscopic partial nephrectomy for complex renal tumors. World journal surg oncol [Internet]. 2021 [citado 03/01/2022]; 19(1): 282. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/34537060/
19. Quintana-Rodríguez M, Hernández Campoalegre M, Gonzalez-Leon T. Complicaciones en la prostatectomía simple laparoscópica. Rev Cubana Urol [Internet]. 2023 [citado 18/04/2023]; 12(1): e926. Disponible en: https://revurologia.sld.cu/index.php/rcu/article/view/926
20. Domínguez A, Muñoz-Rodríguez J, Martos R, Parejo V, Prera Á, Tremps C, et al. Progressive perioperative benefits of laparoscopy in combination with an ERAS (Enhanced Recovery After Surgery) protocol in radical cystectomy with ileal conduit. Actas Urológicas Españolas [Internet]. 2021 [citado 24/01/2023]; 45(4): 289-99. Disponible en: https://www.sciencedirect.com/science/article/pii/S2173578621000433
Downloads
Published
How to Cite
Issue
Section
License
Authors who have publications with this journal agree to the following terms: Authors will retain their copyrights and grant the journal the right of first publication of their work, which will be publication of their work, which will be simultaneously subject to the Creative Commons Attribution License (CC-BY-NC 4.0) that allows third parties to share the work as long as its author and first publication in this journal are indicated.
Authors may adopt other non-exclusive license agreements for distribution of the published version of the work (e.g.: deposit it in an institutional telematic archive or publish it in a volume). Likewise, and according to the recommendations of the Medical Sciences Editorial (ECIMED), authors must declare in each article their contribution according to the CRediT taxonomy (contributor roles). This taxonomy includes 14 roles, which can be used to represent the tasks typically performed by contributors in scientific academic production. It should be consulted in monograph) whenever initial publication in this journal is indicated. Authors are allowed and encouraged to disseminate their work through the Internet (e.g., in institutional telematic archives or on their web page) before and during the submission process, which may produce interesting exchanges and increase citations of the published work. (See The effect of open access). https://casrai.org/credit/
