OBJECTIVE: To assess postoperative complication profiles and 30-day mortality (30 dM) in older patients undergoing either laparoscopic radical nephrectomy (LRN) compared with open partial nephrectomy (OPN) or laparoscopic partial nephrectomy (LPN) for early stage renal cell carcinoma.
METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare linked database, 2277 patients aged >65 years with T1 renal cell carcinoma, who underwent LRN, OPN, or LPN were identified (1992-2005). Surgical and medical complications and 30 dM after nephrectomy were abstracted. Bivariate and multivariate logistic regression analyses were performed.
RESULTS: Relative to LRN, the rate of surgical complications was higher for OPN (28% vs 20%; P< .001) and LPN (29% vs 20%; P=.01). These differences persisted after multivariate adjustment for patient and tumor characteristics (OPN: odds ratio, 1.6; 95% confidence interval, 1.28-1.91; P< .001; LPN: odds ratio, 1.6; 95% confidence interval, 1.13-2.39; P=.01). Specifically, relative to LRN, OPN was associated with a 7% higher rate of genitourinary complications (13% vs 20%; P< .001). Similarly, relative to LRN, LPN was associated with a 7% higher rate of genitourinary complications (13% vs 20%; P=.001) and with a 4% higher rate of hemorrhagic complications (8% vs 4%; P=.02). No statistically significant differences were recorded for all other surgical and/or medical complication types and 30 dM (all P≥.2).
CONCLUSION: The complication and 30-dM rates were not different between LRN, OPN, and LPN groups. Exceptions include genitourinary complications that favor LRN relative to OPN and LPN and hemorrhagic complications that favor LRN relative to LPN. It is doubtful that these results should discourage the use of partial nephrectomy relative to LRN in older patients.
Written by:
Becker A, Ravi P, Roghmann F, Trinh QD, Tian Z, Larouche A, Kim S, Shariat SF, Kluth L, Dahlem R, Fisch M, Graefen M, Eichelberg C, Karakiewicz PI, Sun M. Are you the author?
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Mayo Clinic, Rochester, MN; Department of Urology, Comprehensive Cancer Center of the Medical University of Vienna, Austria; Department of Urology, University-Hospital Hamburg-Eppendorf, Hamburg, Germany; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
Reference: Urology. 2014 Jun;83(6):1285-91.
doi: 10.1016/j.urology.2014.01.050
PubMed Abstract
PMID: 24862392
UroToday.com Renal Cancer Section
