title: Complications of contemporary radical nephrectomy: comparison of open vs. laparoscopic approach.
abstract: Increasingly, laparoscopy is being employed in the treatment of urologic malignancies. This is most apparent in kidney cancer, where laparoscopic radical nephrectomy is now considered to be a gold standard. Herein, we compared early postoperative morbidity in a contemporary series of open and laparoscopic radical nephrectomies. We reviewed all patients that underwent a radical nephrectomy between October 1999 and May 2001 at our institution. We then compared open radical nephrectomy patients to those undergoing laparoscopic approaches with specific attention to early complications. A total of 74 radical nephrectomies were performed: 41 open, 18 hand-assisted and 15 pure laparoscopic nephrectomies. Overall, complication rates between the open, hand-assist and pure laparoscopic groups were similar (10%, 17% and 12%, respectively, P = 0.133). There was no statistically significant difference in ASA score (P = 0.144), pre-operative hematocrit (P = 0.575) or intra-operative blood loss (P = 0.364). The open nephrectomy group had a statistically larger average tumor size (7.4 cm vs. 4.6 cm; P = 0.005) and younger average age (57 vs. 63; P = 0.019) than the laparoscopic group. Length of hospital stay was significantly shorter in the laparoscopic group (3.6 days vs. 1.7 days; P < 0.0001). Laparoscopic radical nephrectomy has an acceptably low complication rate and compares favorably to open radical nephrectomy. The low rate of complications combined with the advantages of laparoscopic surgery favor a laparoscopic approach for the majority of patients with stage T1 and T2 tumors.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Shuford
authors.forename: Elspeth M
authors.initials: EM
authors.lastname: McDougall
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: Bonnie J
authors.initials: BJ
authors.lastname: LaFleur
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D016896:Treatment Outcome