title: Outcomes and Management Considerations in Patients on Dialysis Undergoing Laparoscopic Radical Nephrectomy for Renal-Cell Carcinoma.
abstract: OBJECTIVE
  To analyze the perioperative outcomes and management considerations in patients with dialysis-dependent end-stage renal disease (ESRD) undergoing laparoscopic radical nephrectomy for renal-cell carcinoma (RCC).
  
  
  METHODS
  There were 224 consecutive laparoscopic radical nephrectomies reviewed. Of those, 37 patients with ESRD were identified and compared with 187 patients with sporadic RCC. Evaluable parameters included age, sex, race, side of surgery, medical comorbidities, body mass index, American Society of Anesthesiologist (ASA) scoring, and age adjusted Charlson Comorbidity Index. All complications occurring intraoperatively and within the first 30 days were classified as per the Clavien classification system. Presurgical workup and transplant considerations were evaluated. Demographic and clinical characteristics were compared using Student t tests and chi-square tests for categoric variables.
  
  
  RESULTS
  Compared with non-ESRD patients, those with ESRD were younger and had smaller tumors. ASA was significantly higher in the ESRD group (P<0.001). Mean blood loss was similar between ESRD patients and non-ESRD patients. Overall complication rates were higher in patients with ESRD. Pathologic characteristics of ESRD renal masses included a higher proportion of papillary RCC.
  
  
  CONCLUSIONS
  Patients with RCC associated with ESRD tend to have a higher ASA class and lower grade tumors. In addition, this population is at increased risk of surgical complications and more likely to need transfusions. Careful preoperative preparation and intraoperative anesthetic management are crucial to minimize patient morbidity and improve outcomes.
authors.affiliation: Department of Urology, Albert Einstein College of Medicine , Bronx, New York.
authors.forename: Aryeh
authors.initials: A
authors.lastname: Keehn
authors.affiliation: Department of Urology, Albert Einstein College of Medicine , Bronx, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Maiman
authors.affiliation: Department of Urology, Albert Einstein College of Medicine , Bronx, New York.
authors.forename: Ilir
authors.initials: I
authors.lastname: Agalliu
authors.affiliation: Department of Urology, Albert Einstein College of Medicine , Bronx, New York.
authors.forename: Jacob
authors.initials: J
authors.lastname: Taylor
authors.affiliation: Department of Urology, Albert Einstein College of Medicine , Bronx, New York.
authors.forename: Reza
authors.initials: R
authors.lastname: Ghavamian
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D007680:Kidney Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D009518:New York; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies