title: Transperitoneal laparoscopic radical nephrectomy for patients with dialysis-dependent end-stage renal disease: an analysis and comparison of perioperative outcome.
abstract: OBJECTIVE
  To evaluate LRN as treatment for high risk patients. Laparoscopic radical nephrectomy (LRN) is performed for renal tumors not amenable to nephron-sparing treatments. Indications are increasing to include higher risk patients including those with end-stage renal disease (ESRD) necessitating dialysis.
  
  
  METHODS
  We performed a retrospective analysis of a patient cohort with clinical stage T1 renal tumors undergoing transperitoneal LRN. Parameters examined included patient demographics, medical comorbidities, tumor characteristics, operative outcomes, and complications.
  
  
  RESULTS
  One hundred eighty-nine patients underwent 195 LRN. Sixteen patients (8.5%) had preexistent ESRD requiring dialysis. A higher American Society of Anesthiologists score (P<.05), higher age-adjusted Charlson comorbidity index (P=.003), higher incidence of previous abdominal surgery (P=.012), and higher incidence of hypertension (P=.025) were found for the ESRD group. Mean blood loss was 153.0 and 132.0 mL (P=.71) in the ESRD patients and non-ESRD patients, respectively. A longer stay (P=.02) was noted for ESRD patients. Mean tumor size in the ESRD patients and non-ESRD patients was 2.6 and 4.2 cm (P<.05), respectively. Renal cell carcinoma was the most common pathology in 14 of 20 (70.0%) ESRD patient renal units and 167 of 175 (95.4%) non-ESRD patient renal units (P=.001). Intraoperative and postoperative complication rates were 6.3% and 31.3% respectively for ESRD patients (P=.05), and 8.7% and 21.4% respectively for non-ESRD patients (P=.35). Most postoperative complications were minor.
  
  
  CONCLUSIONS
  LRN, for the treatment of renal tumors in ESRD patients requiring dialysis, is feasible and safe with acceptable intraoperative and postoperative complication rates. Patients with ESRD may require longer hospital stay after LRN.
authors.affiliation: Department of Urology, Division of Transplantation, University of Miami Miller School of Medicine, Miami, Florida 33136, USA. vbird@med.miami.edu
authors.forename: Vincent G
authors.initials: VG
authors.lastname: Bird
authors.forename: John M
authors.initials: JM
authors.lastname: Shields
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aziz
authors.forename: Rosely
authors.initials: R
authors.lastname: De Los Santos
authors.forename: Rajnikanth
authors.initials: R
authors.lastname: Ayyathurai
authors.forename: Gactano
authors.initials: G
authors.lastname: Ciancio
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality; D009399:Nephrons / Q000601:surgery; D010537:Peritoneum / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011336:Probability; D012016:Reference Values; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome