TY - JOUR
T1 - Complications of contemporary open nephron sparing surgery
T2 - A single institution experience
AU - Thompson, R. Houston
AU - Leibovich, Bradley C.
AU - Lohse, Christine M.
AU - Zincke, Horst
AU - Blute, Michael L.
PY - 2005/9
Y1 - 2005/9
N2 - Purpose: Open nephron sparing surgery (NSS) is now the standard of care for small renal tumors irrespective of overall renal function. More recently laparoscopic NSS with hilar clamping has emerged, albeit with relatively longer ischemic times. We reviewed our experience with contemporary open NSS, comparing complication rates to those of historical controls and updating data for comparison with minimally invasive procedures. Materials and Methods: From 1985 to 2001, 823 open NSSs were performed at our institution. Early (within 30 days of NSS) and late (30 days to 1 year) complications were compared using the chi-square and Wilcoxon rank sum tests between procedures performed in 1985 to 1995 (control group of 343 patients) and 1996 to 2001 (contemporary group of 480). Results: In the control vs the contemporary group there were significant decreases in intra-operative blood loss (median 550 vs 350 cc, p <0.001), chronic renal insufficiency/failure (14.6% vs 8.1%, p = 0.003), dialysis need (7.0% vs 2.1%, p <0.001) and any early (13.4% vs 6.9%, p = 0.002) or late (32.4% vs 24.6%, p = 0.014) complication. In the contemporary group 50% of patients did not require pedicle clamping, 32% underwent warm ischemia (median 12 minutes) and 18% underwent cold ischemia (median 27 minutes). In addition, patients with a warm ischemia time of 20 minutes or less had fewer early complications than patients with greater than 20 minutes of ischemia, although this did not attain statistical significance (3.8% vs 13.6%, p = 0.063). Conclusions: Complications resulting from open NSS have significantly decreased with time. Contemporary open NSS is associated with minimal morbidity, and decreases the need for pedicle clamping and overall ischemia time.
AB - Purpose: Open nephron sparing surgery (NSS) is now the standard of care for small renal tumors irrespective of overall renal function. More recently laparoscopic NSS with hilar clamping has emerged, albeit with relatively longer ischemic times. We reviewed our experience with contemporary open NSS, comparing complication rates to those of historical controls and updating data for comparison with minimally invasive procedures. Materials and Methods: From 1985 to 2001, 823 open NSSs were performed at our institution. Early (within 30 days of NSS) and late (30 days to 1 year) complications were compared using the chi-square and Wilcoxon rank sum tests between procedures performed in 1985 to 1995 (control group of 343 patients) and 1996 to 2001 (contemporary group of 480). Results: In the control vs the contemporary group there were significant decreases in intra-operative blood loss (median 550 vs 350 cc, p <0.001), chronic renal insufficiency/failure (14.6% vs 8.1%, p = 0.003), dialysis need (7.0% vs 2.1%, p <0.001) and any early (13.4% vs 6.9%, p = 0.002) or late (32.4% vs 24.6%, p = 0.014) complication. In the contemporary group 50% of patients did not require pedicle clamping, 32% underwent warm ischemia (median 12 minutes) and 18% underwent cold ischemia (median 27 minutes). In addition, patients with a warm ischemia time of 20 minutes or less had fewer early complications than patients with greater than 20 minutes of ischemia, although this did not attain statistical significance (3.8% vs 13.6%, p = 0.063). Conclusions: Complications resulting from open NSS have significantly decreased with time. Contemporary open NSS is associated with minimal morbidity, and decreases the need for pedicle clamping and overall ischemia time.
KW - Kidney
KW - Kidney neoplasms
KW - Laparoscopy
KW - Nephrectomy
KW - Postoperative complications
UR - http://www.scopus.com/inward/record.url?scp=23744489542&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=23744489542&partnerID=8YFLogxK
U2 - 10.1097/01.ju.0000169453.29706.42
DO - 10.1097/01.ju.0000169453.29706.42
M3 - Article
C2 - 16093969
AN - SCOPUS:23744489542
SN - 0022-5347
VL - 174
SP - 855
EP - 858
JO - Journal of Urology
JF - Journal of Urology
IS - 3
ER -