Objective:

Comparative analysis of postoperative complications according to approach (open and laparoscopic) and surgical technique (radical and partial nephrectomy) in patients with renal cancer c T1.

Material and methods:

A retrospective analysis of 480 patients with renal cancer c T1 treated by surgery between 1990-2010. Complications in the first 60 days after surgery were evaluated (Clavien-Dindo classification). Complications Clavien ≥III were severe. Patients was clasificated in four cohort: 1) Open radical nephrectomy (ORN);2) laparoscopic radical nephrectomy (LRN) ;3) open partial nephrectomy (OPN); 4) laparoscopic partial nephrectomy (LPN). Univariate and multivariate analysis have been performed using Cox regression to determine variables with relate to the complications.

Results:

In 198(41,3%) patients was performed ORN and in 155(32,3%) LRN. In the group of partial nephrectomies, 51 cases (10.6%) were open and 76 (15.8%) laparoscopic. Complications occurred in 20.2% of patients. The most frequent was Clavien II (13%). 25.8% undergoing ORN developed complications, in the LRN group 16,8% experienced complications (p=0.09). No significant difference in distribution of complications between laparoscopic and open approach in partial nephrectomy (OPN-15.7%, LPN-15.8%). The group of ORN had more complications than the other groups (of type Clavien-II), but there were not differences between severe complications. In the multivariable analysis laparoscopic radical nephrectomy behaved as independent predictive variable of complications (OR=0.41, p=0.007). In the multivariable analysis of Clavien≥III complication, no predictor or protective factor was identified.

Conclusion:

Laparoscopic radical nephrectomy decreased the total postoperative complications to more than half. In severe complications (Clavien ≥III) no predictors of complications were identified.