ENDOUROLOGY & LAPAROSCOPY

Complications of Laparoscopic Surgery for Urological Cancer: A Single Institution Analysis
Colombo JR Jr, Haber GP, Jelovsek JE, Nguyen M, Fergany A, Desai MM, Kaouk JH, Gill IS
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio
J Urol. 2007; 178:786-91

• Purpose: We determined the incidence of and risk factors for perioperative complications associated with laparoscopic oncological surgery for urological malignancy.
• Materials and Methods: All records of patients undergoing laparoscopic surgery for urological malignancy at a tertiary care institution from April 1997 through January 2006 were reviewed. Relevant demographic and perioperative data during and within 6 weeks of surgery were evaluated retrospectively. Various factors were analyzed to estimate risk of a perioperative complication such as the Charlson Comorbidity Index, American Society of Anesthesiologists score, European Scoring System for laparoscopic urological operations and surgeon experience. Logistic regression was used to identify independent risk factors for perioperative complications.
• Results: A total of 1,867 laparoscopic oncological surgeries were performed, including radical or partial nephrectomy, nephroureterectomy, radical prostatectomy and radical cystectomy. Perioperative complications occurred in 12.4% of patients, including 3.5% intraoperatively and 8.9% postoperatively. Intraoperative (2.3%) and postoperative hemorrhage (2.7%) accounted for 40% of all perioperative complications. All cause perioperative mortality occurred in 8 patients (0.4%). On multivariate analysis radical cystectomy (adjusted OR 4.9, p < 0.001), partial nephrectomy (adjusted OR 2.4, p < 0.001), length of surgery greater than 4 hours (adjusted OR 2.5, p < 0.001) and preoperative serum creatinine greater than 1.5 mg/dL (adjusted OR 2.1, p = 0.04) were independent risk factors for perioperative complications. Comparing the periods of 1997 to 2000 vs. 2001 to 2005, despite a significant increase in technical complexity of procedures (European Scoring System 9.8 vs. 60.6, p < 0.001), the incidence of complications tended to decrease (17.3% vs. 12.5%, p = 0.3).
• Conclusions: In appropriately selected patients laparoscopic urological oncological surgery is safe. These data on perioperative complications could possibly serve as a reference benchmark for practicing urologists.
  
  
• Editorial Comment
  Since the first laparoscopic surgery in urology was performed in 1990, questions about the efficiency and safety of this minimally invasive technique have been challenged, particularly in the urological oncologic field. The strength of this manuscript is the large experience with complex oncological procedures performed laparoscopically in a single institution. The complication rates are comparable to open technique even when the complexity of the cases increased. The authors should be congratulated for the improvement of minimally invasive surgery in Urological oncology benefiting patients with good clinical outcome.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA
E-mail: fernando.kim@uchsc.edu