title: Complications of laparoscopic surgery for urological cancer: a single institution analysis.
abstract: OBJECTIVE
  We determined the incidence of and risk factors for perioperative complications associated with laparoscopic oncological surgery for urological malignancy.
  
  
  METHODS
  All records of patients undergoing laparoscopic surgery for urological malignancy at a tertiary care institution from April 1997 through January 2006 were reviewed. Relevant demographic and perioperative data during and within 6 weeks of surgery were evaluated retrospectively. Various factors were analyzed to estimate risk of a perioperative complication such as the Charlson Comorbidity Index, American Society of Anesthesiologists score, European Scoring System for laparoscopic urological operations and surgeon experience. Logistic regression was used to identify independent risk factors for perioperative complications.
  
  
  RESULTS
  A total of 1,867 laparoscopic oncological surgeries were performed, including radical or partial nephrectomy, nephroureterectomy, radical prostatectomy and radical cystectomy. Perioperative complications occurred in 12.4% of patients, including 3.5% intraoperatively and 8.9% postoperatively. Intraoperative (2.3%) and postoperative hemorrhage (2.7%) accounted for 40% of all perioperative complications. All cause perioperative mortality occurred in 8 patients (0.4%). On multivariate analysis radical cystectomy (adjusted OR 4.9, p <0.001), partial nephrectomy (adjusted OR 2.4, p <0.001), length of surgery greater than 4 hours (adjusted OR 2.5, p <0.001) and preoperative serum creatinine greater than 1.5 mg/dl (adjusted OR 2.1, p = 0.04) were independent risk factors for perioperative complications. Comparing the periods of 1997 to 2000 vs 2001 to 2005, despite a significant increase in technical complexity of procedures (European Scoring System 9.8 vs 60.6, p <0.001), the incidence of complications tended to decrease (17.3% vs 12.5%, p = 0.3).
  
  
  CONCLUSIONS
  In appropriately selected patients laparoscopic urological oncological surgery is safe. These data on perioperative complications could possibly serve as a reference benchmark for practicing urologists.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Jose R
authors.initials: JR
authors.lastname: Colombo
authors.forename: Georges-Pascal
authors.initials: GP
authors.lastname: Haber
authors.forename: J Eric
authors.initials: JE
authors.lastname: Jelovsek
authors.forename: Mike
authors.initials: M
authors.lastname: Nguyen
authors.forename: Amr
authors.initials: A
authors.lastname: Fergany
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D015653:Cystectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects; D011183:Postoperative Complications; D011468:Prostatectomy / Q000009:adverse effects; D014571:Urologic Neoplasms / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects*