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01-10-2017 | Original Article

Minimally invasive vs open nephrectomy in the modern era: does approach matter?

Authors: David M. Golombos, Bilal Chughtai, Quoc-Dien Trinh, Dominique Thomas, Jialin Mao, Alexis Te, Padraic O’Malley, Douglas S. Scherr, Joseph Del Pizzo, Jim C. Hu, Art Sedrakyan

Published in: World Journal of Urology | Issue 10/2017

Abstract

Purpose

To evaluate if the widespread adoption of a minimally invasive approach to radical nephrectomy has affected short- and long-term patient outcomes in the modern era.

Methods

A retrospective cohort study of patients who underwent radical nephrectomy from 2001 to 2012 was conducted using the US National Cancer Institute Surveillance Epidemiology and End Results (SEER) Program and Medicare insurance program database. Patients who underwent open surgery were compared to those who underwent minimally invasive surgery using propensity score matching.

Results

10,739 (85.9%) underwent open surgery and 1776 (14.1%) underwent minimally invasive surgery. Minimally invasive surgery increased from 18.4% from 2001–2004 to 43.5% from 2009 to 2012. After median follow-up of 57.1 months, minimally invasive radical nephrectomy conferred long-term oncologic efficacy in terms of overall (HR 0.84; 95% CI 0.75–0.95) survival and cancer-specific (HR 0.68; 95% CI 0.54–0.86) survival compared to open radical nephrectomy. Minimally invasive surgery was associated with lower risk of inpatient death [risk ratio (RR) 0.45 with 95% CI: (0.20–0.99), p = 0.04], deep vein thrombosis [RR: 0.35 (0.18–0.69), p = 0.002], respiratory complications [RR: 0.73 (0.60–0.89), p = 0.001], infectious complications [RR: 0.35 (0.14–0.90), p = 0.02], acute kidney injury [RR: 0.66 (0.52–0.84), p < 0.001], sepsis [RR: 0.55 (0.31–0.98), p = 0.04], prolonged length of stay (18.6 vs 30.0%, p < 0.001), and ICU admission (19.7 vs 26.3%, p < 0.001). Costs were similar between the two approaches (30-day costs $15,882 vs $15,564; p = 0.70).

Conclusion

After widespread adoption of minimally invasive approaches to radical nephrectomy across the United States, oncologic standards remain preserved with improved perioperative outcomes at no additional cost burden.

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Title: Minimally invasive vs open nephrectomy in the modern era: does approach matter?
Authors: David M. Golombos
Bilal Chughtai
Quoc-Dien Trinh
Dominique Thomas
Jialin Mao
Alexis Te
Padraic O’Malley
Douglas S. Scherr
Joseph Del Pizzo
Jim C. Hu
Art Sedrakyan
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 10/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-017-2040-6

At a glance: The STEP trials

Springer Medicine

Minimally invasive vs open nephrectomy in the modern era: does approach matter?

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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