Outcomes assessment of laparoscopic partial nephrectomy: is there an increased rate of postoperative bleeding events?
William V. Shappley, III, M.D.1, Sandip M. Prasad, M.D.1, Michaella M. Prasad, M.D.1, Jodi Mechaber, N.P.2, Anna Dowdle, B.S.2, Andrew A. Wagner, M.D.2.
1Brigham & Women's Hospital, Boston, MA, USA, 2Beth Israel Deaconess Medical Center, Boston, MA, USA.
BACKGROUND: Laparoscopic partial nephrectomy is an accepted surgical approach for the treatment of renal masses. Outcomes research in this area has focused on oncologic and intraoperative parameters, but less is known about postoperative complications, particularly related to delayed bleed (DB).
METHODS: A retrospective review was performed of the prospectively-monitored laparoscopic renal tumor database at Beth Israel Deaconess Medical Center. Demographic, perioperative, and postoperative information was gathered on all patients undergoing laparoscopic partial nephrectomy by a single surgeon between 2007 and 2009.
RESULTS: A total of 41 patients underwent laparoscopic partial nephrectomy. There were no intraoperative complications. There was one open conversion to a subcostal incision to remove a 15cm tumor. Postoperative complications occurred in 22% of patients. There was one postoperative bleed requiring transfusion and 3 DBs, one requiring transfusion. All 3 DBs were in men (mean age 47) within 4 weeks of surgery and were treated conservatively with hospitalization and bed rest. One patient underwent angiography which did not reveal a bleeding source.
|Sex: N (%)|
|Age (y): mean (range)||53.4 (36-85)|
|ASA score: mean||2.2|
|O.R. time (min): median (range)||193 (129-379)|
|Clamp time (min): median (range)||28 (17-60)|
|EBL (mL): median (range)||100 (25-900)|
|Technique: N (%)|
|Pure Lap||35 (85.4%)|
|Length of stay (d): mean||2.6|
|Tumor size (cm): mean (range)||2.8 (0.6-15.1)|
|Positive margin: N (%)|
|Malignant tumors||2 (5.7%)|
|Transfusions: N (%)||2 (4.9%)|
|Complications: N (%)|
|Immediate bleed||1 (2.4%)|
|Delayed bleed||3 (7.3%)|
|Urinary retention||1 (2.4%)|
|Wound infection||1 (2.4%)|
|Median nerve palsy||1 (2.4%)|
|Follow-Up (mo): mean (range)||10.4 (1-29)|
CONCLUSIONS: In this single institution experience, perioperative and oncologic outcomes were in keeping with other published reports. The incidence of delayed bleeding was 7% and only occurred in relatively young men. Consideration may be given to instituting a longer interval between surgery and routine physical activity in this patient population.