Fewer complications after laparoscopic nephrectomy as compared to the open procedure with the modified Clavien classific
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
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, Qiang Ding and Hao-wen Jiang*
Abstract Background: The objective of the study is to compare complication rates of laparoscopic nephrectomy and open nephrectomy using a standardized classification method Methods: We 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. Results: The 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. Conclusions: In 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. Keywords: Clavien classification system, Complication, Laparoscopy, Nephrectomy
Background Renal tumor is one of the most frequently diagnosed urological tumors, ranking eighth among all the tumors in the United States in 2012 [1]. Laparoscopic technology was applied in urological surgeries soon after it was put in practice. In 1991, the first laparoscopic nephrectomy was performed by Clayman and colleagues [2]. Since then, a number of studies [3,4] have reported that laparoscopic surgery offers several advantages over traditional open surgery (such as alleviating postoperative pain, a decreased
* Correspondence: [email protected] Department of Urology, Huashan Hospital, Fudan University, 12 WuLuMuQi Middle Road, 200040 Shanghai, PR China
length of hospital stay and earlier recovery), while achieving equivalent cancer control. Besides the long-term outcome of nephrectomy, the short-term postoperation outcome (mainly the complication rate) is also generally used to demonstrate the quality of care which has been provided to the patient. Several studies [4,5] reported that laparoscopic nephrectomy had similar complication rates to open nephrectomy. The Clavien classification system (CCS) ha
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