Laparoscopic Radical Nephrectomy vs Laparoscopic or Open Partial Nephrectomy for T1 Renal Cell Carcinoma
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Laparoscopic Radical Nephrectomy vs Laparoscopic or Open Partial Nephrectomy for T1 Renal Cell Carcinoma : Comparison of Complication Rates in Elderly Patients During the Initial Phase of Adoption. / Becker, Andreas; Ravi, Praful; Roghmann, Florian; Trinh, Quoc-Dien; Tian, Zhe; Larouche, Alexandre; Kim, Simon; Shariat, Shahrokh F; Kluth, Luis; Dahlem, Roland; Fisch, Margit; Graefen, Markus; Eichelberg, Christian; Karakiewicz, Pierre I; Sun, Maxine.
in: UROLOGY, Jahrgang 83, Nr. 6, 01.06.2014, S. 1285-1291.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Laparoscopic Radical Nephrectomy vs Laparoscopic or Open Partial Nephrectomy for T1 Renal Cell Carcinoma
T2 - Comparison of Complication Rates in Elderly Patients During the Initial Phase of Adoption
AU - Becker, Andreas
AU - Ravi, Praful
AU - Roghmann, Florian
AU - Trinh, Quoc-Dien
AU - Tian, Zhe
AU - Larouche, Alexandre
AU - Kim, Simon
AU - Shariat, Shahrokh F
AU - Kluth, Luis
AU - Dahlem, Roland
AU - Fisch, Margit
AU - Graefen, Markus
AU - Eichelberg, Christian
AU - Karakiewicz, Pierre I
AU - Sun, Maxine
N1 - Copyright © 2014 Elsevier Inc. All rights reserved.
PY - 2014/6/1
Y1 - 2014/6/1
N2 - 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.
AB - 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.
U2 - 10.1016/j.urology.2014.01.050
DO - 10.1016/j.urology.2014.01.050
M3 - SCORING: Journal article
C2 - 24862392
VL - 83
SP - 1285
EP - 1291
JO - UROLOGY
JF - UROLOGY
SN - 0090-4295
IS - 6
ER -