MP63-13 INCIDENCE OF MAJOR COMPLICATIONS FOR LAPAROSCOPIC RADICAL AND ROBOTIC PARTIAL NEPHRECTOMY: A MATCH-PAIRED ANALYSIS (2015)

You have accessJournal of UrologyKidney Cancer: Surgical Therapy IV1 Apr 2015MP63-13 INCIDENCE OF MAJOR COMPLICATIONS FOR LAPAROSCOPIC RADICAL AND ROBOTIC PARTIAL NEPHRECTOMY: A MATCH-PAIRED ANALYSIS Oliver Ko, Daniel Ramirez, Homayoun Zargar, Oktay Akca, Andrew McElroy, Georges-Pascal Haber, Jihad Kaouk, and Robert Stein Oliver KoOliver Ko More articles by this author , Daniel RamirezDaniel Ramirez More articles by this author , Homayoun ZargarHomayoun Zargar More articles by this author , Oktay AkcaOktay Akca More articles by this author , Andrew McElroyAndrew McElroy More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , and Robert SteinRobert Stein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2345AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A recent study called into question the emphasis on nephron sparing surgery “at all costs.” We sought to evaluate the incidence of major complications in laparoscopic radical nephrectomy (LRN) versus robotic partial nephrectomy (RPN) in a matched-paired analysis. METHODS We performed a match-paired analysis (1:1 ratio) based on tumor complexity assessed by RENAL score. Baseline demographics along with perioperative and oncologic outcomes were analyzed. A major complication was defined as Clavien grade ≥ III. RESULTS From October 2006 - May 2014, 382 patients (191 pairs) were matched for inclusion in the study. Compared to the RPN group, patients in the LRN group were older (62.9 vs. 60.3; p =.04), had a higher Charlson comorbidity score (6 vs. 4; p <.001) and had a higher proportion of CKD stage ≥ 3 (34% vs. 16.8%; p < 0.001). There was no difference in the intraoperative complication rate for LRN vs. RPN (4.2% vs. 6.3%; p =.36). The total post-op complication rate was higher in LRN vs. RPN (42.9% vs. 30.9%; p <.015). The major postoperative complication rate was similar in the LRN group (5.2%) versus the RPN group (5.8%), p=1.00. In regards to other outcomes, the LRN group compared to the RPN group, demonstrated comparable, positive surgical margin rates (.6% vs. 1.4%; p = 0.5), comparable all cause mortality and incidence of metastases (6.3% vs. 4.7%; p =.5) and (5.2% vs. 3.7%; p =.4) respectively, and greater loss of GFR (69.4% preservation (58.5 - 83.6%) vs. 84.3% (72.9 - 97.6); p <.001) On multivariate analysis, age was the single predictor of development of post-operative complication (OR 1.1 CI (1.04 – 1.18); p=.002) in our series. Average follow-up for LRN compared to RPN was (19 months (5 - 32 months) vs. 33 months (7.3 - 53 months); p <.001). CONCLUSIONS The majority of post-operative complications are minor, and the rate of major post-operative complications after RPN is comparable to LRN regardless of tumor complexity. RPN offers similar oncologic results with the benefit of renal function preservation when compared to LRN. For enhancing renal masses, RPN should be strongly considered when feasible. Table 1. Demographics and Outcomes of LRN vs. RPN Demographics / Outcomes LRN (n=191) RPN (n=191) p value Age±SD, years 62.9±(12.7) 60.3±(11.2) 0.04 BMI, kg/m2 29.6±(6.9) 30.7±(6.2) 0.12 Male gender, n (%) 115 (60.2) 124 (64.9) 0.34 Left side, n (%) 96.8 (50.7) 105.4 (55.2) 0.64 Charlson score 6 (5-8) 4 (3-5) < 0.001 Solitary Kidney, n (%) 0 4 (2.1) 0.12 Tumor size on CT, cm 6.2 (4.5-8.4) 3.8 (0.4-5) < 0.001 Mean R.E.N.A.L. Score 9 (8-10) 9 (8-10) 1 Simple (4-6) R.E.N.A.L. Score, n (%) 12 (6.3) 12 (6.3) 1 Intermediate (7-9) R.E.N.A.L. Score, n (%) 85 (44.5) 85 (44.5) 1 Complex (10-12) R.E.N.A.L. Score, n (%) 94 (49.2) 94 (49.2) 1 Preoperative eGFR 69.1 (55.9-82.3) 84.1 (67.6-97.7) < 0.001 CKD stage≥III, n (%) 65 (34) 32 (16.8) < 0.001 Operative time, min 160 (130-210) 180.5 (164-240) < 0.001 Estimated blood loss, ml 137.5 (100-250) 200 (100-350) < 0.001 Warm ischemia time, min N/A 25(19-30) N/A Hospital Stay, days 4 (4-5) 3 (3-4) < 0.001 Intraoperative complication, n (%) 8 (4.2) 12 (6.3) 0.36 Intraoperative transfusion, n (%) 6 (2.6) 2 (7.1) 0.59 Mean Postoperative Complication, n (%) 82 (42.9) 59 (30.9) 0.015 Minor Postoperative Complication, n (%) 72 (37.7) 48 (25.1) 0.01 Major Postoperative Complication, n (%) 10 (5.2) 11 (5.8) 1 Postoperative transfusion, n (%) 3 (1.6) 25 (13.1) < 0.001 Conversion, n (%) 2 (0.7) 5 (24.1) 1 LPN 4 RN N/A All-cause mortality, n (%) 12 (6.3) 9 (4.7) 0.5 Metastasis occurrence, n (%) 10 (5.2) 7 (3.7) 0.4 % Of eGFR preservation (1-2 years) 69.4 (58.5-83.6) 84.3 (72.9-97.6) < 0.001 Follow up, months 19 (5-32) 33 (7.3-53) < 0.001 Values expressed as median (IQR) and counts (%) © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e793-e794 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oliver Ko More articles by this author Daniel Ramirez More articles by this author Homayoun Zargar More articles by this author Oktay Akca More articles by this author Andrew McElroy More articles by this author Georges-Pascal Haber More articles by this author Jihad Kaouk More articles by this author Robert Stein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...