Complications of laparoscopic partial nephrectomy

We report our experience with laparoscopic partial nephrectomy (LPN) to identify preoperative factors associated with an increased risk of postoperative complications.

Among patients undergoing LPN, we analyzed demographic and preoperative tumor characteristics as the exposure variables and postoperative complications as the outcomes. Multivariable logistic regression modeling identified variables associated with increased risk of complications.

Of 336 consecutive patients undergoing LPN, 120 (35.7%) had a complication, including 22 (6.6%) with major complications, 12 (3.6%) developing urine leak, 29 (8.6%) requiring blood transfusion, and 11 (3.3%) undergoing nephrectomy. There were no perioperative deaths. On univariable analysis, larger tumor diameter increased the odds of any complication (odds ratio [OR] 2.3, P = 0.007), hemorrhage (OR 1.4, P = 0.007), and urine leak (OR 1.7, P = 0.001). Each 1 cm increase in tumor diameter was associated with a 33% increased odds of a major complication (P = 0.04). In a multivariable model, changes in tumor diameter increased the odds of any complication (OR 2.4, P = 0.006) and hemorrhage (OR 1.5, P = 0.01); tumor depth was a better predictor of a major complication (OR 1.1, P = 0.004). In the multivariable model, advanced age also was associated with hemorrhage (OR 2.6, P = 0.05).

Tumor diameter, depth of tumor penetration, and advanced patient age are associated with increased odds of complications in patients undergoing LPN. This information is important for counseling patients preoperatively regarding their risk of complications following LPN and in selecting the appropriate intervention for a particular tumor.