Laparoscopic and open partial nephrectomy: complication comparison using the Clavien system.
OBJECTIVE
To compare postoperative complications in patients undergoing laparoscopic and open partial nephrectomy using a standardized complication-reporting system and a standardized tumor-scoring system.


METHODS
We conducted a retrospective analysis  of 189 consecutive patients with nephrometry scores available who underwent elective partial nephrectomy for renal masses. Demographic, perioperative, and complication data were recorded. By using the modified Clavien scale, we graded 30- and 90-day complication rates.


RESULTS
107 patients underwent laparoscopic partial nephrectomy and 82 underwent open partial nephrectomy (N=189). Open partial nephrectomy patients had higher nephrometry scores than laparoscopic patients had (7.1±2.4 vs. 5.6±1.8, P<.001). Surgical and hospitalization times were  shorter, and estimated blood loss was lower in the laparoscopic group (P<.001). At 30 days, there were more overall complications in the open group, but more major complications in the laparoscopic group (P>.05). After multivariable logistic regression analysis, only higher body mass  index and higher estimated blood loss were predictors of more overall complications.


CONCLUSIONS
Laparoscopic partial nephrectomy has the advantages of decreased operative time, lower blood loss, and shorter hospital stay. The complication rate in the laparoscopic group is similar  to that in the open group, despite favorable tumor characteristics in the laparoscopic group.
Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10065, USA.
Jennifer E
JE
Reifsnyder
Ranjith
R
Ramasamy
Casey K
CK
Ng
James
J
Dipietro
Benjamin
B
Shin
Shahrokh F
SF
Shariat
Joseph J
JJ
Del Pizzo
Douglas S
DS
Scherr
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult