Fewer complications after laparoscopic nephrectomy as compared to the open procedure with the modified Clavien classification system - a retrospective analysis from Southern China

World Journal of Surgical Oncology

Hao-wen Jiang¹  Qiang Ding¹  Hua Xu¹ 

[1] Department of Urology, Huashan Hospital, Fudan University, 12 WuLuMuQi Middle Road, 200040 Shanghai, PR China

关键词: Nephrectomy;    Laparoscopy;    Complication;    Clavien classification system;   

Others  :  1148488
DOI  :  10.1186/1477-7819-12-242

 received in 2014-04-12, accepted in 2014-07-20,  发布年份 2014

【 摘 要 】

Background

The objective of the study is to compare complication rates of laparoscopic nephrectomy and open nephrectomy using a standardized classification method

Methods

We retrospectively included 843 patients from March 2006 to November 2012, of whom 88 had laparoscopic radical nephrectomy (LRN), 526 had open radical nephrectomy (ORN), 42 had laparoscopic partial nephrectomy (LPN), and 187 had open partial nephrectomy (OPN). A modified Clavien classification system was applied to quantify complications of nephrectomy. Fisher’s exact or chi-square test were used to compare complication rates between laparoscopic and open approaches.

Results

The overall complication rate was 19.31%, 30.04%, 35.71%, and 36.36% in LRN, ORN, LPN, and OPN, respectively. More Grade II complications (odds ratio = 2.593, 95% CI 1.172 to 5.737, P = 0.010) and longer postoperation hospital stay (9.2 days and 7.6 days, P < 0.001) were observed in ORN compared with LRN. In multivariable analysis, surgical approach (LRN/ORN) (P = 0.036), age (P = 0.044), height (P = 0.020), systolic pressure (P = 0.012), fasting blood glucose level (P = 0.032), and blood loss during operation (P = 0.011) were significant predictors for grade II complications in radical nephrectomy. LPN had similar complication rates compared with OPN.

Conclusions

In conclusion, LRN had the advantages of less grade II complications and shorter postoperation hospital stay than ORN. Older age and more blood loss during operation would also contribute to more grade II complications in radical nephrectomy.

【 授权许可】

   
2014 Xu et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Siegel R, Naishadham D, Jemal A: Cancer Statistics, 2012. CA Cancer J Clin 2012, 62:10-29.
• [2]Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, Roemer FD, Pingleton ED, Thomson PG, Long SR: Laparoscopic nephrectomy: initial case report. J Urol 1991, 146:278-282.
• [3]Dunn MD, Portis AJ, Shalhav AL, Elbahnasy AM, Heidorn C, McDougall EM, Clayman RV: Laparoscopic versus open radical nephrectomy: a 9-year experience. J Urol 2000, 164:1153-1159.
• [4]Shuford MD, McDougall EM, Chang SS, LaFleur BJ, Smith JA Jr, Cookson MS: Complications of contemporary radical nephrectomy: comparison of open vs laparoscopic approach. Urol Oncol 2004, 22:121-126.
• [5]Reifsnyder JE, Ramasamy R, Ng CK, Dipietro J, Shin B, Shariat SF, Del Pizzo JJ, Scherr DS: Laparoscopic and open partial nephrectomy: complication comparison using the Clavien system. JSLS 2012, 16:38-44.
• [6]Clavien PA, Sanabria JR, Strasberg SM: Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992, 111:518-526.
• [7]Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004, 240:205-213.
• [8]WHO Expert Consultation: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004, 363:157-163.
• [9]Kurta JM, Thompson RH, Kundu S, Kaag M, Manion MT, Herr HW, Russo P: Contemporary imaging of patients with a renal mass: does size on computed tomography equal pathological size? BJU Int 2009, 103:24-27.
• [10]Lopez-Beltran A, Scarpelli M, Montironi R, Kirkali Z: WHO classification of the renal tumors of the adults. Eur Urol 2004, 2006(49):798-805.
• [11]Weingart SN, Iezzoni LI, Davis RB, Palmer RH, Cahalane M, Hamel MB, Mukamal K, Phillips RS, Daves DT, Banks NJ: Use of administrative data to find substandard care - Vvalidation of the complications screening program. Med Care 2000, 38:796-806.
• [12]Tan HJ, Wolf JS Jr, Ye Z, Wei JT, Miller DC: Complications and failure to rescue after laparoscopic versus open radical nephrectomy. J Urol 2011, 186:1254-1260.
• [13]Lowrance WT, Yee DS, Savage C, Cronin AM, O’Brien MF, Donat SM, Vickers A, Russo P: Complications after radical and partial nephrectomy as a function of age. J Urol 2010, 183:1725-1730.
• [14]Parsons JK, Varkarakis I, Rha KH, Jarrett TW, Pinto PA, Kavoussi LR: Complications of abdominal urologic laparoscopy: longitudinal five-year analysis. Urology 2004, 63:27-32.
• [15]Simon SD, Castle EP, Ferrigni RG, Lamm DL, Swanson SK, Novicki DE, Andrews PE: Complications of laparoscopic nephrectomy: the Mayo clinic experience. J Urol 2004, 171:1447-1450.