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Bic A, Mazeaud C, Salleron J, Bannay A, Balkau B, Larose C, Hubert J, Eschwège P. Complications after partial nephrectomy: robotics overcomes open surgery and laparoscopy: the PMSI French national database. BMC Urol 2023; 23:146. [PMID: 37715175 PMCID: PMC10502976 DOI: 10.1186/s12894-023-01322-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE To evaluate three partial nephrectomies (PN) procedures: open (OPN), standard laparoscopy (LPN), and robot-assisted laparoscopy (RAPN), for the risk of initial complications and rehospitalization for two years after the surgery. MATERIALS AND METHODS From the French national hospital database (PMSI-MCO), every hospitalization in French hospitals for renal tumor PN in 2016-2017 were extracted. Complications were documented from the initial hospitalization and any rehospitalization over two years. Chi-square and ANOVA tests compared the frequency of complications and length of initial hospitalization between the three surgical procedures. Relative risks (RR) and 95% confidence intervals were computed. RESULTS The 9119 initial hospitalizations included 4035 OPN, 1709 LPN, and 1900 RAPN; 1475 were excluded as the laparoscopic procedure performed was not determined. The average length of hospitalization was 8.1, 6.2, and 4.5 days for OPN, LPN, and RAPN, respectively. Compared to OPN, there were fewer complications at the time of initial hospitalization for the mini-invasive procedures: 29% for OPN vs. 20% for LPN (0.70 [0.63;0.78]) and 12% for RAPN (RR=0.43, 95%CI [0.38;0.49]). For RAPN compared to LPN, there were fewer haemorrhages (RR=0.55 [0.43;0.72]), anemia (0.69 {0.48;0.98]), and sepsis (0.51 [0.36;0.71]); during follow up, there were fewer urinary tract infections (0.64 [0.45;0.91]) but more infectious lung diseases (1.69 [1.03;2.76]). Over the two-year postoperative period, RAPN was associated with fewer acute renal failures (RR=0.73 [0.55;0.98]), renal abscesses (0.41 [0.23;0.74]), parietal complications (0.69 [0.52;0.92]) and urinary tract infections (0.54 [0.40;0.73]) than for OPN. CONCLUSIONS Conservative renal surgery is associated with postoperative morbidity related to the surgical procedure fashion. Mini-invasive procedures, especially robot-assisted surgery, had fewer complications and shorter hospital lengths of stay.
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Affiliation(s)
- Antoine Bic
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France.
- Department of Urology, Nancy University Hospital, Avenue de Bourgogne, Vandoeuvre Cedex, 54511, France.
| | - Charles Mazeaud
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
| | - Julia Salleron
- Département de Biostatistiques, Institut de Cancérologie de Lorraine, 6 avenue de Bourgogne CS 30519, Vandoeuvre-lès-Nancy Cedex, 54519, France
| | - Aurélie Bannay
- Service d'Évaluation et Information Médicales, CHRU Nancy, Nancy, France
| | - Beverley Balkau
- Épidémiologie Clinique, Centre de Recherche en Épidémiologie et Santé des Populations, Institut National de la Santé et de la Recherche Médicale U1018, Université Paris-Saclay, USVQ, Université Paris-Sud, Villejuif, F-94807, France
| | - Clément Larose
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
| | - Jacques Hubert
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
| | - Pascal Eschwège
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
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Khalil MI, Ubeda J, Soehner T, Bhandari NR, Payakachat N, Davis R, Raheem OA, Kamel MH. Contemporary Perioperative Morbidity and Mortality Rates of Minimally Invasive vs Open Partial Nephrectomy in Obese Patients with Kidney Cancer. J Endourol 2019; 33:920-927. [PMID: 31333072 DOI: 10.1089/end.2019.0310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: To compare early postoperative morbidity and mortality rates in obese patients (body mass index ≥30 kg/m2) who underwent minimally invasive partial nephrectomy (MIPN) vs open partial nephrectomy (OPN), utilizing the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods: The NSQIP database was queried to identify obese patients who underwent either MIPN or OPN between 2008 and 2016. Patient demographics, comorbidities, operative time (OT), length of stay (LOS), and 30-day postoperative complications, readmissions, and mortality rates were recorded and compared between the two groups. Multivariable logistic regression analysis was used to determine the adjusted odds of early postoperative complications in MIPN vs OPN. Results: A total of 6041 obese MIPN patients and 3064 obese OPN patients were identified. Mean OT (minutes ± standard deviation) was longer for MIPN vs OPN (197.2 ± 71.0 vs 189.6 ± 82.4, p < 0.001), while mean LOS (3.8 ± 2.8 days vs 5.8 ± 3.5 days, p < 0.001) and 30-day complications (8.5% vs 19.8%, p < 0.001) were lower. No difference in 30-day postoperative mortality rates between MIPN (0.4%) and OPN (0.5%) was observed (p = 0.426). In the adjusted analysis, the odds of any complication within 30 days in the MIPN group were 61% lower, blood transfusion 73% lower, pneumonia 38% lower, sepsis 70% lower, acute renal failure 64% lower, superficial surgical site infection 40% lower, and reoperation 47% lower, compared with OPN patients. Conclusions: When compared with OPN in obese patients, the likelihood of 30-day postoperative morbidity was significantly lower in MIPN patients. However, the odds of 30-day mortality rates were similar between the groups.
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Affiliation(s)
- Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Joel Ubeda
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Thomas Soehner
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Naleen Raj Bhandari
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, Louisiana
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Urology, Ain Shams University, Cairo, Egypt
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Veccia A, Derweesh IH, Antonelli A, Autorino R. Re: The Temporal Association of Robotic Surgical Diffusion with Overtreatment of the Small Renal Mass. Eur Urol 2019; 75:877-878. [PMID: 30728098 DOI: 10.1016/j.eururo.2019.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/22/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Alessandro Veccia
- Division of Urology, VCU Health System and McGuire VA Medical Center, Richmond, VA, USA; Division of Urology, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Alessandro Antonelli
- Division of Urology, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Riccardo Autorino
- Division of Urology, VCU Health System and McGuire VA Medical Center, Richmond, VA, USA.
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Shah PH, Alom MA, Leibovich BC, Thompson RH, Uzzo RG, Kavoussi LR, Richstone L, Bhindi B, Habermann EB, Joshi V, Boorjian SA. The Temporal Association of Robotic Surgical Diffusion with Overtreatment of the Small Renal Mass. J Urol 2018; 200:981-988. [PMID: 29792881 DOI: 10.1016/j.juro.2018.05.081] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE We evaluated contemporary practice patterns in the management of small renal masses. MATERIALS AND METHODS We identified 52,804 patients in the NCDB (National Cancer Database) who were diagnosed with a small renal mass (4 cm or less) between 2010 and 2014. Utilization trends of active surveillance, ablation and robotic, laparoscopic and open surgical techniques were compared among all comers, elderly patients 75 years old or older and individuals with competing health risks, defined as a Charlson index of 2 or greater. Multivariable logistic regression models were used to assess factors associated with robotic renal surgery and active surveillance. RESULTS Surgery remained the primary treatment modality across all years studied, performed in 75.0% and 74.2% of cases in 2010 and 2014, respectively. Although increases in active surveillance from 4.8% in 2010 to 6.0% in 2014 (p <0.001) and robotic renal surgery (22.1% in 2010 to 39.7% in 2014, p <0.001) were observed, the increase in the proportion of small renal masses treated with robotic partial and radical nephrectomy was greater than that of active surveillance (82.0% and 63.0%, respectively, vs 25.0%). Subgroup analyses in individuals 75 years old or older, or with a Charlson index of 2 or greater likewise revealed preferential increases in robotic surgery vs active surveillance. On multivariable analysis later year of diagnosis was associated with increased performance of robotic renal surgery compared to active surveillance (2014 vs 2010 OR 1.44, 95% CI 1.20-1.72, p <0.001) and nonrobotic procedural interventions (2014 vs 2010 OR 2.59, 95% CI 2.30-2.93, p <0.001). CONCLUSIONS Robotic surgical extirpation has outpaced the adoption of active surveillance of small renal masses. This raises concern that the diffusion of robotic technology propagates overtreatment, particularly among elderly and comorbid individuals.
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Affiliation(s)
- Paras H Shah
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Manaf A Alom
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Robert G Uzzo
- Division of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Louis R Kavoussi
- Department of Urology, Northwell Health, New Hyde Park, New York
| | - Lee Richstone
- Department of Urology, Northwell Health, New Hyde Park, New York
| | - Bimal Bhindi
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth B Habermann
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Vidhu Joshi
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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Pereira J, Renzulli J, Pareek G, Moreira D, Guo R, Zhang Z, Amin A, Mega A, Golijanin D, Gershman B. Perioperative Morbidity of Open Versus Minimally Invasive Partial Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program. J Endourol 2018; 32:116-123. [PMID: 29121786 PMCID: PMC5824659 DOI: 10.1089/end.2017.0609] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES In recent years, there has been a shift to minimally invasive partial nephrectomy (MIPN) with the dissemination of robot-assisted technology. However, contemporary data on the comparative morbidity of open partial nephrectomy (OPN) and MIPN are lacking. We, therefore, evaluated the perioperative morbidity of OPN and MIPN using a contemporary national cohort. METHODS We identified 13,658 patients aged 18 to 89 who underwent PN from 2010 to 2015 in the National Surgical Quality Improvement Program (NSQIP) database, of whom 9018 (66.0%) underwent MIPN. The associations of MIPN with 30-day morbidity were evaluated using logistic regression, adjusted for patient features. RESULTS Median age at surgery was 60 (interquartile range [IQR] 51, 68) years. Overall, 30-day complications occurred in 6.7% of patients. Compared with OPN, MIPN was associated with lower rates of 30-day complications (4.9% vs 10.1%, p < 0.0001), perioperative blood transfusion (3.8% vs 12.5%, p < 0.0001), prolonged hospitalization (5.6% vs 23.4%, p < 0.0001), readmission (4.4% vs 7.8%, p < 0.0001), reoperation (1.8% vs 3.2%, p < 0.0001), and 30-day mortality (0.3% vs 0.6%, p = 0.001). On multivariable analysis, MIPN was independently associated with a reduced risk of 30-day complications (odds ratio [OR] 0.46, p < 0.0001), perioperative blood transfusion (OR 0.27, p < 0.0001), prolonged hospitalization (OR 0.19, p < 0.0001), readmission (OR 0.59, p < 0.0001), and reoperation (OR 0.57, p < 0.0001). Postoperative complications occurred predominantly early after surgery, whereas hospital readmissions and reoperation occurred at a consistent rate. CONCLUSIONS In this contemporary national cohort, MIPN was independently associated with reduced rates of 30-day complications, perioperative blood transfusion, prolonged hospitalization, hospital readmission, and reoperation, compared with OPN.
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Affiliation(s)
- Jorge Pereira
- Minimally Invasive Urology Institute, The Miriam Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island
| | - Joseph Renzulli
- Minimally Invasive Urology Institute, The Miriam Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island
| | - Gyan Pareek
- Minimally Invasive Urology Institute, The Miriam Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island
| | - Daniel Moreira
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
| | - Ruiting Guo
- Department of Biostatistics, Brown University, Providence, Rhode Island
| | - Zheng Zhang
- Department of Biostatistics, Brown University, Providence, Rhode Island
| | - Ali Amin
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pathology & Laboratory Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Anthony Mega
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Hematology/Oncology, The Miriam Hospital, Providence, Rhode Island
| | - Dragan Golijanin
- Minimally Invasive Urology Institute, The Miriam Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island
| | - Boris Gershman
- Minimally Invasive Urology Institute, The Miriam Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island
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Wallis CJ, Garbens A, Chopra S, Gill IS, Satkunasivam R. Robotic Partial Nephrectomy: Expanding Utilization, Advancing Innovation. J Endourol 2017; 31:348-354. [DOI: 10.1089/end.2016.0639] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Christopher J.D. Wallis
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Alaina Garbens
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Sameer Chopra
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Inderbir S. Gill
- USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Raj Satkunasivam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
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