Laparoscopic Nephroureterectomy Associated With Higher Risk of Adverse Events (open access)

medical news

 June 06, 2016

TAKE-HOME MESSAGE

• While similar in concept and approach, laparoscopic radical nephrectomy (LRN) and laparoscopic nephroureterectomy (LNU) are performed for different indications. The authors of this retrospective study evaluated 4904 patients using the National Surgical Quality Improvement Program database to compare 30-day complication risks following LNU (n = 745) and LRN (n = 4159). Complications were higher in patients undergoing LNU than LRN (21% vs 12%; P < .01). These patients also had a 50% higher risk of requiring a transfusion (9% LNU vs 6% LRN). The authors identify age, ASA ≥3, elevated creatinine, blood transfusion >4 units prior to surgery, and operative time >6 hours as independent risk factors for perioperative complications.
  
• The difference in complications between LNU and LRN indicates that the nature of the different diseases imposes increased risk for LNU, and surgeons must be aware of these challenges when counseling patients on surgery.

open access:

Can Urol Assoc J.

Introduction

Cancers of the upper urinary tract are common, with an estimated 63 920 new cases involving the kidney/renal pelvis and at least 3000 new cases involving the ureter in the U.S. in 2014.¹ Tumours originating in the renal parenchyma are usually treated with radical or partial nephrectomy, and tumours originating in the upper tract urothelium (ureter and renal pelvis) are usually treated with nephroureterectomy, where the ureter is removed in addition to the kidney.^2–4

Laparoscopic renal surgery has become the standard of care for patients with low-stage malignancies because this approach is associated with easier convalescence and equivalent cancer outcomes.⁵ Both laparoscopic radical nephrectomy (LRN) and laparoscopic nephroureterectomy (LNU) have been associated with reduced blood loss, complications, postoperative pain, and length of hospital stay compared to open surgery.^3,4,6,7

While LRN and LNU are performed for different malignancies, the operative steps are similar, with the exception of the distal ureter and bladder dissection required for LNU. Because LRN and LNU are technically similar, some surgeons and patients may believe the perioperative risks are the same. Furthermore, since LRN is performed more often than LNU, surgeons may be disproportionately influenced by the experience of LRN patients.

The objective of this study was to compare postoperative complications up to 30 days following surgery for patients undergoing LRN and LNU. We hypothesized that the frequency and type of postoperative complications experienced after LRN and LNU would be different. Directly comparing postoperative complications of LRN and LNU will allow clinicians to better prepare and counsel patients for surgery.....