Predictors of complications following retroperitoneoscopic total and partial nephrectomy
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Nov 2018 · 1 min read
In brief
In brief
Retrospective analysis of 173 minimally invasive nephrectomies (119 total, 54 partial) in children demonstrates that retroperitoneoscopic approach achieves favorable outcomes with 1.9% conversion rate and 13.1% reoperation rate. Predictors of complications include vessel closure technique, ESRF, and need for concomitant procedures, while the retroperitoneal approach itself does not increase complication risk compared to transperitoneal technique.
Written by the GCMD Library team from the article.
Introduction
Recent reports in the literature suggest an increased risk of complications with retroperitoneal as opposed to transperitoneal approach to partial nephrectomy (PN) and total nephrectomy (TN). We are a large unit performing predominantly retroperitoneoscopic PN and TN. We aim to review our outcomes and perform analysis to elucidate the predictors of complications following the retroperitoneal approach for extirpative kidney surgery.
Methods
We performed a single center retrospective review of children undergoing MIMS TN and PN between 2005 and 2015. Variables were tested for association with outcomes using Chi2 and Spearman's Rho correlation.
Results
We performed 173 MIMS nephrectomies, 119 total and 54 partial. Median age and weight were 5 years (6 months to 18 years) and 24.9 kg (7.7 to 85 kg) and operative time 147 min. There were 4 conversions and 17 postoperative complications. 19.6% children required further surgery, including 8 completion stumpectomies. Retroperitoneal approach did not have increased risk compared to transperitoneal for need of further surgery. Partial nephrectomy was not associated with higher rate of intraoperative complication or LOS. Predictors of intraoperative complication were vessel closure technique. Associations with need for further surgery were: ESRF, contralateral disease, bladder dysfunction, presence of PD catheter, and need for concomitant procedure.
Conclusion
Our conversion rate (1.9%) and need for further surgery (13.1%) following the retroperitoneal approach to the kidney are favorable to the literature. Need for reoperation is often associated with the underlying diagnosis and the natural sequelae of the disease process.
Level of evidence
IV.