title: Quality of life and perioperative outcomes after retroperitoneoscopic radical nephrectomy (RN), open RN and nephron-sparing surgery in patients with renal cell carcinoma.
abstract: OBJECTIVE
  To prospectively evaluate health-related quality of life (HRQoL) and perioperative outcomes in patients with T1 and T2 renal cell carcinoma (RCC) after retroperitoneoscopic radical nephrectomy (RRN), open RN (ORN) or open nephron-sparing surgery (NSS).
  
  
  METHODS
  The data of 117 patients who had undergone RRN (36), ORN (37) or NSS (44) were evaluated. RRN data were obtained at Basel University Hospital, Switzerland, while the ORN and NSS data were collected at the University of Munich, Germany. Perioperative outcomes were analysed and compared. HRQoL was prospectively evaluated based on the Short Form 36 questionnaire with a mean follow-up of 22 months.
  
  
  RESULTS
  Operative duration was significantly longer in the RRN group compared with the ORN and NSS groups, at a mean (sem) of 146 (42) min vs 113 (48) min and 114 (42) min (P < 0.001). In the RRN group intraoperative blood loss was lower than in the ORN and NSS groups, at a mean (sem) of 231 (153) mL vs 424 (361) mL and 494 (360) mL (P < 0.001). Morbidity rates were 13.9% for RRN, 16.2% for ORN and 20.5% for NSS, the most relevant complications being bleeding requiring transfusions in RRN and NSS patients and haemorrhage (5% of patients in each group). Creatinine values at 6 months after surgery only recovered completely in the NSS group. Patients in the ORN group had a trend towards higher mental well-being scores than patients in the RRN and NSS groups, with a mean Mental Component Summary Score of 48.3 vs 48.0 and 44.5, respectively (not statistically significant), while all patients were in similar physical condition after surgery, with a mean Physical Component Summary Scores of 48.0 (ORN), 47.4 (RRN) and 47.2 (NSS). The physical condition scores of patients in all groups were higher than scores reached by an age and sex-matched population (45.8).
  
  
  CONCLUSIONS
  These real-world data show that each of the surgical techniques can be considered safe. Importantly, after surgery patients reported high QoL scores independent of the technique used.
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich, Germany. christian.gratzke@med.unimuenchen.de
authors.forename: Christian
authors.initials: C
authors.lastname: Gratzke
authors.forename: Michael
authors.initials: M
authors.lastname: Seitz
authors.forename: Florian
authors.initials: F
authors.lastname: Bayrle
authors.forename: Boris
authors.initials: B
authors.lastname: Schlenker
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.forename: Niko
authors.initials: N
authors.lastname: Haseke
authors.forename: Markus
authors.initials: M
authors.lastname: Bader
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.forename: Alexander
authors.initials: A
authors.lastname: Roosen
authors.forename: Alexander
authors.initials: A
authors.lastname: Karl
authors.forename: Oliver
authors.initials: O
authors.lastname: Reich
authors.forename: Wael Y
authors.initials: WY
authors.lastname: Khoder
authors.forename: Stephen
authors.initials: S
authors.lastname: Wyler
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Michael
authors.initials: M
authors.lastname: Staehler
authors.forename: Alexander
authors.initials: A
authors.lastname: Bachmann
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006304:Health Status; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D009399:Nephrons / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome