Laparoscopic Radical Nephrectomy vs Laparoscopic or Open Partial Nephrectomy for T1 Renal Cell Carcinoma: Comparison of Complication Rates in Elderly Patients During the Initial Phase of Adoption - 25/05/14
, Praful Ravi c, Florian Roghmann a, Quoc-Dien Trinh d, e, Zhe Tian a, Alexandre Larouche a, Simon Kim f, Shahrokh F. Shariat g, Luis Kluth h, Roland Dahlem h, Margit Fisch h, Markus Graefen b, Christian Eichelberg a, Pierre I. Karakiewicz a, Maxine Sun aAbstract |
Objective |
To assess postoperative complication profiles and 30-day mortality (30 dM) in older patients undergoing either laparoscopic radical nephrectomy (LRN) compared with open partial nephrectomy (OPN) or laparoscopic partial nephrectomy (LPN) for early stage renal cell carcinoma.
Methods |
Using the Surveillance, Epidemiology, and End Results-Medicare linked database, 2277 patients aged >65 years with T1 renal cell carcinoma, who underwent LRN, OPN, or LPN were identified (1992-2005). Surgical and medical complications and 30 dM after nephrectomy were abstracted. Bivariate and multivariate logistic regression analyses were performed.
Results |
Relative to LRN, the rate of surgical complications was higher for OPN (28% vs 20%; P <.001) and LPN (29% vs 20%; P = .01). These differences persisted after multivariate adjustment for patient and tumor characteristics (OPN: odds ratio, 1.6; 95% confidence interval, 1.28-1.91; P <.001; LPN: odds ratio, 1.6; 95% confidence interval, 1.13-2.39; P = .01). Specifically, relative to LRN, OPN was associated with a 7% higher rate of genitourinary complications (13% vs 20%; P <.001). Similarly, relative to LRN, LPN was associated with a 7% higher rate of genitourinary complications (13% vs 20%; P = .001) and with a 4% higher rate of hemorrhagic complications (8% vs 4%; P = .02). No statistically significant differences were recorded for all other surgical and/or medical complication types and 30 dM (all P ≥.2).
Conclusion |
The complication and 30-dM rates were not different between LRN, OPN, and LPN groups. Exceptions include genitourinary complications that favor LRN relative to OPN and LPN and hemorrhagic complications that favor LRN relative to LPN. It is doubtful that these results should discourage the use of partial nephrectomy relative to LRN in older patients.
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| Andreas Becker and Praful Ravi contributed equally. |
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| Financial Disclosure: Pierre I. Karakiewicz is partially supported by the University of Montreal Health Center Urology Specialists, Fonds de la Recherche en Santé du Quebec, the University of Montreal Department of Surgery, and the University of Montreal Health Center (CHUM) Foundation. The remaining authors declare that they have no relevant financial interests. |
Vol 83 - N° 6
P. 1285-1293 - juin 2014 Retour au numéro
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