Comparison of perioperative outcomes of retroperitoneal and transperitoneal minimally invasive partial nephrectomy after adjusting for tumor complexity Journal Article

Authors: Gin, G. E.; Maschino, A. C.; Spaliviero, M.; Vertosick, E. A.; Bernstein, M.; Coleman, J. A.
Article Title: Comparison of perioperative outcomes of retroperitoneal and transperitoneal minimally invasive partial nephrectomy after adjusting for tumor complexity
Abstract: Objective To evaluate and compare perioperative outcomes of transperitoneal and retroperitoneal (RP) laparoscopic and robotic partial nephrectomies (LPNs) while adjusting for tumor complexity. Materials and Methods Retrospective review was conducted of 191 patients who underwent transperitoneal (n = 116) or RP (n = 75) LPN. To adjust for tumor complexity, individual components of the radius, exophytic or endophytic properties, nearness to the collecting system or sinus, anterior or posterior location, and location in reference to polar lines (R.E.N.A.L.) nephrometry score were used in multivariate linear and logistic regression models to compare perioperative outcomes between the 2 groups. A propensity approach was also used to adjust for multiple covariates. Investigated outcomes included estimated blood loss (EBL), ischemia and operative times, length of hospital stay, margin status, opioid use, postoperative estimated glomerular filtration rate, complications within 30 days, and readmission rates. Results Tumors resected by RPLPN were more likely to have lower complexity score by nephrometry (P = .04). Four of the 5 components of the R.E.N.A.L. nephrometry score were significantly different between the groups. After adjustment for these factors, a lower EBL was noted in the RP group (β, -97; 95% confidence interval, -156 to -39; P =.001). Risk of readmission for the RP group was significantly lower (odds ratio, 0.15; P =.024) using propensity analysis. Conclusion Using adjustment for tumor complexity, RPLPN was associated with lower EBL and readmission rates supporting the potential clinical advantage for this approach when feasible.
Keywords: adult; controlled study; treatment outcome; aged; middle aged; cancer surgery; survival rate; retrospective studies; major clinical study; mortality; pathophysiology; comparative study; cancer staging; outcome assessment; follow up; follow-up studies; neoplasm staging; laparoscopy; laparoscopic surgery; linear models; cohort studies; logistic models; cohort analysis; pathology; surgical approach; retrospective study; kidney neoplasms; nephrectomy; risk assessment; length of stay; narcotic analgesic agent; partial nephrectomy; kidney tumor; operation duration; scoring system; surgery; intermethod comparison; glomerulus filtration rate; minimally invasive surgery; multivariate analysis; neoplasm invasiveness; perioperative period; robotics; hospital readmission; statistical model; patient controlled analgesia; postoperative pain; blood loss, surgical; drug use; retroperitoneum; retroperitoneal space; peritoneum; peroperative complication; tumor invasion; procedures; propensity score; minimally invasive surgical procedures; operative time; operative blood loss; humans; human; male; female; priority journal; article; robotic surgical procedure; retroperitoneal laparoscopic and robotic partial nephrectomy; transperitoneal laparoscopic and robotic partial nephrectomy
Journal Title: Urology
Volume: 84
Issue: 6
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2014-12-01
Start Page: 1355
End Page: 1360
Language: English
DOI: 10.1016/j.urology.2014.07.045
PUBMED: 25288573
PROVIDER: scopus
Notes: Export Date: 2 March 2015 -- Source: Scopus
Citation Impact
MSK Authors
  1. Jonathan Coleman
    233 Coleman
  2. Greg Everett Gin
    1 Gin