Differences in the complications according to the approach and type of nephrectomy in renal cancer CT1 treated with surgery

Abstract

Objective: Comparative analysis of postoperative complications according to approach (open and laparoscopic) and surgical technique (radical and partial nephrectomy) in patients with renal cancer c T1.
 Material and methods: A retrospective analysis of 480 patients with renal cancer c T1 treated by surgery between 1990-2010. Complications in the first 60 days after surgery were evaluated (Clavien-Dindo classification).Complications Clavien≥III were severe.
 Patients was clasificated in four cohort: 1) Open radical nephrectomy (ORN);2) laparoscopic radical nephrectomy (LRN) ;3) open partial nephrectomy (OPN) ; 4) laparoscopic partial nephrectomy (LPN).
 Univariate and multivariate analysis have been performed using Cox regression to determine variables with relate to the complications.
 Results: In 198(41,3%) patients was performed ORN and in 155(32,3%)LRN. In the group of partial nephrectomies, 51 cases (10.6%) were open and 76 (15.8%) laparoscopic.
 Complications occurred in 20.2% of patients. The most frequent was Clavien II (13%). 25,8% undergoing ORN developed complications, in the LRN group 16,8% experienced complications (p=0,09). No significant difference in distribution of complications between laparoscopic and open approach in partial nephrectomy (OPN-15,7%, LPN-15,8%)
 The group of ORN had more complications than the other groups (of type Clavien-II), but there were not differences between severe complications.
 In the multivariable analysis laparoscopic radical nephrectomy behaved as independent predictive variable of complications (OR=0,41, p=0,007). In the multivariable analysis of Clavien≥III complication, no predictor or protective factor was identified.
 Conclusion: Laparoscopic radical nephrectomy decreased the total postoperative complications to more than half. In severe complications (Clavien ≥ III) no predictors of complications were identified.