title: Fewer complications after laparoscopic nephrectomy as compared to the open procedure with the modified Clavien classification system--a retrospective analysis from southern China.
abstract: BACKGROUND
  The objective of the study is to compare complication rates of laparoscopic nephrectomy and open nephrectomy using a standardized classification method.
  
  
  METHODS
  We retrospectively included 843 patients from March 2006 to November 2012, of whom 88 had laparoscopic radical nephrectomy (LRN), 526 had open radical nephrectomy (ORN), 42 had laparoscopic partial nephrectomy (LPN), and 187 had open partial nephrectomy (OPN). A modified Clavien classification system was applied to quantify complications of nephrectomy. Fisher's exact or chi-square test were used to compare complication rates between laparoscopic and open approaches.
  
  
  RESULTS
  The overall complication rate was 19.31%, 30.04%, 35.71%, and 36.36% in LRN, ORN, LPN, and OPN, respectively. More Grade II complications (odds ratio = 2.593, 95% CI 1.172 to 5.737, P = 0.010) and longer postoperation hospital stay (9.2 days and 7.6 days, P < 0.001) were observed in ORN compared with LRN. In multivariable analysis, surgical approach (LRN/ORN) (P = 0.036), age (P = 0.044), height (P = 0.020), systolic pressure (P = 0.012), fasting blood glucose level (P = 0.032), and blood loss during operation (P = 0.011) were significant predictors for grade II complications in radical nephrectomy. LPN had similar complication rates compared with OPN.
  
  
  CONCLUSIONS
  In conclusion, LRN had the advantages of less grade II complications and shorter postoperation hospital stay than ORN. Older age and more blood loss during operation would also contribute to more grade II complications in radical nephrectomy.
authors.forename: Hua
authors.initials: H
authors.lastname: Xu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Ding
authors.affiliation: Department of Urology, Huashan Hospital, Fudan University, 12 WuLuMuQi Middle Road, 200040 Shanghai, PR China. haowen_jiang@126.com.
authors.forename: Hao-wen
authors.initials: HW
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009392:Nephrectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies
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