1653 PERIOPERATIVE AND PATHOLOGIC OUTCOMES OF LAPAROSCOPIC RADICAL NEPHRECTOMY FOR RENAL CELL CARCINOMA IN PATIENTS WITH DIALYSIS-DEPENDENT END-STAGE RENAL DISEASE

Abstract

You have accessJournal of UrologyKidney Cancer: Localized (IV)1 Apr 20131653 PERIOPERATIVE AND PATHOLOGIC OUTCOMES OF LAPAROSCOPIC RADICAL NEPHRECTOMY FOR RENAL CELL CARCINOMA IN PATIENTS WITH DIALYSIS-DEPENDENT END-STAGE RENAL DISEASE Steve Williams, Nicholas Farris, Ilir Agalliu, Luis Ramos, and Reza Ghavamian Steve WilliamsSteve Williams Bronx, NY More articles by this author , Nicholas FarrisNicholas Farris Bronx, NY More articles by this author , Ilir AgalliuIlir Agalliu Bronx, NY More articles by this author , Luis RamosLuis Ramos Bronx, NY More articles by this author , and Reza GhavamianReza Ghavamian Bronx, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3119AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We aimed to analyze the perioperative outcomes of laparoscopic radical nephrectomy for renal masses in patients with dialysis-dependent ESRD in order to reveal perioperative management problems that are unique to these patients. METHODS 224 contemporary laparoscopic radical nephrectomies performed by a single surgeon were reviewed. Of those, 37 patients with ESRD were identified (17%). Evaluable parameters included age, gender, race, medical comorbidities, body mass index, ASA scoring and age adjusted Charlson comorbidity index. End stage renal disease was defined as progression to transplant, dialysis or stage 5 chronic kidney disease. All complications were classified as per the Clavien classication system. Demographic and clinical characteristics were compared using Student t-tests and Chi-square tests for categorical variables, using two-sided test and a significance level alpha=0.05. RESULTS Patient demographics are listed in table 1. Compared to sporadic-RCC, patients with ESRD were younger at diagnosis and had a smaller tumor size. ASA was found to be significantly higher in the ESRD group, while BMI was greater in the non-ESRD group. Mean blood loss was 109 mls and 172 mL in the ESRD patients and non-ESRD patients, respectively. A longer hospital stay (P=.01) was noted for ESRD patients. Overall complication rates by Clavien grade were higher in patients with ESRD. Pathological characteristics of ESRD-RCC included higher proportion of papillary tumor, and a higher proportion of benign disease (30% vs 38%; p<0.05). CONCLUSIONS Laparoscopic nephrectomy for renal malignancy is feasible in patients with end-stage renal failure. The patients with RCC associated with ESRD in this series had lower grade tumors, however, this population is at increased risk of complications. Careful preoperative preparation and intraoperative anesthetic management are crucial to minimize patient morbidity and improve outcomes. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e680 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steve Williams Bronx, NY More articles by this author Nicholas Farris Bronx, NY More articles by this author Ilir Agalliu Bronx, NY More articles by this author Luis Ramos Bronx, NY More articles by this author Reza Ghavamian Bronx, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...