Contemporary open partial nephrectomy is associated with diminished procedure-specific morbidity despite increasing...

Area of Science:

• Nephrology
• Urology
• Surgical Oncology

Background:

• Open partial nephrectomy (OPN) is a standard surgical procedure for renal masses.
• Trends in patient selection, surgical techniques, and perioperative outcomes for OPN are important to understand.

Purpose of the Study:

• To review trends in open partial nephrectomy (OPN) at a single center.
• To analyze changes in patient selection, surgical techniques, and perioperative complications over time.

Main Methods:

• A retrospective chart review of 163 consecutive patients undergoing OPN for renal masses.
• Comparison of patient demographics, tumor characteristics, surgical techniques, and complications across three time periods (1992-1999, 2000-2003, 2004-2008).
• Complications were classified as procedure-specific (PSCs) or non-specific medical complications (NMCs) and graded using CTCAE v3.0.

Main Results:

• An increase in patient BMI and the proportion of central tumors undergoing OPN.
• A decrease in cold ischemia time, reduced estimated blood loss (EBL), and shorter length of stay.
• A significant decline in procedure-specific complications (PSCs) from 16% to 7% (p=0.002).
• Higher BMI was associated with an increased risk of perioperative complications (OR 1.067, p=0.031).

Conclusions:

• OPN is being increasingly applied to more challenging patient populations with central tumors and higher BMIs.
• Despite increased complexity, the rate of procedure-specific complications has decreased.
• Overweight patients undergoing OPN are at a higher risk for non-specific medical complications.