Fewer complications after laparoscopic nephrectomy as compared to the open procedure with the modified Clavien classification system--a retrospective analysis from southern China.

Hua Xu,Hao-Wen Jiang,Qiang Ding

doi:10.1186/1477-7819-12-242

Hua Xu, Hao-Wen Jiang + Show 1 more

Open Access

https://doi.org/10.1186/1477-7819-12-242

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Abstract

BackgroundThe objective of the study is to compare complication rates of laparoscopic nephrectomy and open nephrectomy using a standardized classification methodMethodsWe 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.ResultsThe 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.ConclusionsIn 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.

Highlights

The objective of the study is to compare complication rates of laparoscopic nephrectomy and open nephrectomy using a standardized classification method
Among the 526 patients who had open radical nephrectomy (ORN), five patients were initially scheduled for laparoscopic radical nephrectomy (LRN) and converted to ORN, and 12 patients were initially scheduled for open partial nephrectomy (OPN) and converted to ORN (10 cases were due to urinary collecting system damaged during operation and the other two cases were due to bleeding of the renal wound surface)
Among the 187 patients who had OPN, two patients were initially scheduled for laparoscopic partial nephrectomy (LPN) and converted to OPN

Summary

Introduction

The objective of the study is to compare complication rates of laparoscopic nephrectomy and open nephrectomy using a standardized classification method. Several studies [4,5] reported that laparoscopic nephrectomy had similar complication rates to open nephrectomy. The Clavien classification system (CCS) has been proposed as a mean of quantifying the complications of surgery [6]. It has recently been modified and prospectively validated in a large patient cohort [7]. Few studies have applied the modified CCS in urological surgeries. No study in China has investigated the complication rate of nephrectomy by using this standardized method. We conducted this study to investigate the risk of complications in laparoscopic nephrectomy and open nephrectomy in the Chinese population

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