Decreased complications of contemporary laparoscopic partial nephrectomy: use of a standardized reporting system.
OBJECTIVE
We report complications of laparoscopic partial nephrectomy in a contemporary cohort of 200 patients using a standardized complication reporting system.


METHODS
The records of 200 consecutive patients undergoing laparoscopic partial nephrectomy between September 2003 and November 2005 were reviewed. Mean tumor size was 3 cm and mean parenchymal invasion depth was 1.8 cm. There were 97 central tumors (48.5%) and 9 tumors (4.5%) in a solitary kidney. Complication severity for each patient was graded using a 5-tiered scale based on National Cancer Institute Common Toxicity Criteria. Statistical analysis was done to assess risk factors associated with complication events.


RESULTS
A total of 35 patients (17.5%) had complications. The overall complication rate was 19%. Of the complications 29%, 42%, 26% and 2.6% were grades I to IV, respectively. There were no grade V complications. Median blood loss was 150 ml. Hemorrhagic and urine leak complications occurred in 9 (4.5%) and 4 patients (2%), respectively. Conversion to open partial and laparoscopic radical nephrectomy was done electively in 2 (1%) and 1 patients (0.5%), respectively. Compared to previously reported data on the initial 200 patients in our laparoscopic partial nephrectomy cohort this contemporary group of 200 had statistically significant decreases in overall, urological and hemorrhagic complication rates despite an increase in tumor complexity (p = 0.02, 0.04 and 0.04, respectively).


CONCLUSIONS
Increased experience with advanced laparoscopic techniques has allowed a significantly decreased complication rate following contemporary laparoscopic partial nephrectomy, which now appears comparable to that of open partial nephrectomy. A standardized complication reporting system is advocated.
Simmons
Matthew N
MN
Glickman Urological Institute, Cleveland Clinic, 9500 Euclid Avenue A100, Cleveland, OH 44195, USA.
Gill
Inderbir S
IS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012308:Risk Management; D012720:Severity of Illness Index