[Indications, morbidity and mortality of the open nephrectomy. Analyses of 681 cases and bibliographic review].
OBJECTIVE
To have data about the indications, morbidity and mortality of the nephrectomy by the open approach, to obtain information that could be compared with the laparoscopic approach. To our knowledge there is not a similar review in the Spanish literature since the 60's.


METHODS
We analyzed 681 nephrectomies accounting for a 5.7% of a total of 11.845 operative reports registered in our centre over the last 25 years. For outcome analysis, 93 cadaver donor nephrectomies were excluded. The analysis focuses on three well differentiated areas: kidney transplant surgery, nephrectomies for malignant diseases, and nephrectomies for benign pathologies including a very specific subgroup that includes the infectious-inflammatory diseases. In parallel, we performed a bibliographic review in which more than 87,000 cases of open surgeries where referenced, adding the articles about laparoscopic nephrectomies published over the last decade.


RESULTS
Global mortality of the series (the first 30 postoperative days) was 0.8%, mostly cases of transplant nephrectomies (4), and one upper urinary tract transitional cell carcinoma. Significant morbidity appeared in 47 cases (8%), 15 of which (2.5%) required reoperation, being intensive bleeding with hypovolemia of variable severity the most frequent cause. The series includes non selected cases of a wide spectrum of pathologies. Any comparison with minimally invasive approaches should take into consideration, among other parameters, selection of the cases.
Servicio de Urología y UQTR del Hospital Nuestra Señora de la Esperanza, Barcelona, España. jballesteros@imas.imim.es
Juan José
JJ
Ballesteros Sampol
D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D009392:Nephrectomy / Q000009:adverse effects* / Q000401:mortality*