Comparative analysis of short-term results of retroperitoneoscopic and laparoscopic radical nephrectomy for large kidney tumors

Background: Laparoscopic radical nephrectomy (LRN) and laparoscopic nephroureterectomy (LNU) are similar procedures and some surgeons may counsel both patients groups the same regarding peri-operative risks. The objective of this study is to compare complications following LRN and LNU.Patients and methods: A historical cohort of patients who received LRN or LNU between 2006 and 2012 was reviewed from the National Surgical Quality Improvement Program (NSQIP) database. Patient and surgical characteristics, and outcomes up to 30-days post-operative were abstracted. Univariable and multivariable associations between procedure (LRN or LNU) and any adverse event were determined.Results: During the study period, 4904 patients met inclusion criteria. Of these, 4159 (85%) received a LRN while 745 (15%) received a LNU. LNU was associated with more complications than LRN (21% vs. 12%, respectively, p-value <0.01). The most common complications for LNU vs. LRN, respectively, were: bleeding requiring blood transfusion (9.0% vs. 6.0%), urinary tract infection (4.6% vs. 1.5%), wound infection (1.3% vs. 1.8%), and unplanned intubation (2.3% vs. 0.9%). On multivariable analysis, LNU was associated with higher risk of any complication compared to LRN (RR 1.41, 95% CI 1.16-1.72). Conclusions: Post-operative complications within 30 days of surgery are common after LNU and LRN. Despite having technical similarities, LNU carries a significantly higher risk of short-term complications compared to LRN. This information should be considered when counseling patients prior to surgery.

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Safety and efficacy of inferoposterior access approach to the renal pedicle during transperitoneal laparoscopic radical nephrectomy: A retrospective comparative analysis at a single institution

Journal of Clinical Urology ◽

10.1177/2051415820945532 ◽

2020 ◽

pp. 205141582094553

Author(s):

Xiao-Bao Cheng ◽

Wayne Lam ◽

Zhen-Quan Lu ◽

Richard Lo

Keyword(s):

Comparative Analysis ◽

Radical Nephrectomy ◽

Anterior Approach ◽

Operative Time ◽

Renal Vasculature ◽

Safety And Efficacy ◽

Laparoscopic Radical Nephrectomy ◽

Renal Pedicle ◽

Significant Difference ◽

Approach Group

Purpose To assess the safety and efficacy of transperitoneal laparoscopic radical nephrectomy using an inferoposterior approach to the renal pedicle. Materials and methods A retrospective review of 89 patients who underwent transperitoneal laparoscopic radical nephrectomy by a single surgeon between June 2014 and December 2019 at a single urological unit was carried out. Access to the renal pedicle was via the inferoposterior approach in 48 cases (study group) and 41 were approached via the conventional anterior approach (control group). Patient demographics, intra-operative anatomical findings, and procedural details including operative time on renal pedicles and post-operative outcomes were recorded. Post-operative complications were recorded and classified according to the Clavien-Dindo classification. A comparative analysis between the two groups was performed using Chi-square test and t-test. Results The inferoposterior approach group had a shorter operative time (132.85±26.65 min vs 153.46±39.94 min; p<0.01), which could be attributed to the shorter time spent operating on the renal vasculature (46.31±6.16 min vs 64.46±7.64 min; p<0.01). Lower average blood loss was also observed in the inferoposterior approach group (42 ml vs 62 ml; p<0.05). No significant difference was identified concerning the mean patient age, body mass index, tumor size, number of renal vessels identified, and post-operative length of stay between the two groups. None of the patients required conversion to open. Conclusion Inferoposterior approach to access the renal pedicle during transperitoneal laparoscopic radical nephrectomy is a safe and effective technique, which shortens the operative time when compared to the conventional anterior approach. Level of evidence: Level 3b.

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