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Abstract
Purpose
The aim of this research was to compare surgical outcomes and complications of obese and non-obese patients who underwent open radical nephrectomy (ORN) and laparoscopic radical nephrectomy (LRN).
Materials and Methods
The data of 26 ORN patients and 30 LRN patients between January 2006 and December 2008 were analyzed. Patients with a body mass index (BMI) of 25.0 kg/m2 or more were defined as obese, and those with a BMI of ＜25.0 kg/m2 were defined as non-obese. All patients were divided into two groups according to the criteria above to compare demographic and clinical and pathologic parameters.
Purpose
The aim of this research was to compare surgical outcomes and complications of obese and non-obese patients who underwent open radical nephrectomy (ORN) and laparoscopic radical nephrectomy (LRN).
Materials and Methods
The data of 26 ORN patients and 30 LRN patients between January 2006 and December 2008 were analyzed. Patients with a body mass index (BMI) of 25.0 kg/m2 or more were defined as obese, and those with a BMI of ＜25.0 kg/m2 were defined as non-obese. All patients were divided into two groups according to the criteria above to compare demographic and clinical and pathologic parameters.
Results
The mean BMIs of the 15 obese patients in the ORN group and the 13 obese patients in the LRN group were 26.8±1.1 and 27.7±2.4, respectively. LRN was enormously effective for lowering estimated blood loss (EBL) and postoperative days compared with ORN. Operation times and EBL in ORN were affected by obesity, both of which were increased. In contrast, the data of both LRN groups indicated similar outcomes. The perioperative data of obese patients revealed LRN to have reduced blood loss (143.0±62.7 vs. 446.7±222.4 ml, p=0.001) and not significantly different postoperative days (7.3±2.2 vs. 8.4±1.5 days, p=0.065). Operation time, however, did not differ significantly among obese patients between ORN and LRN. The complications due to LRN had no relation with obesity, whereas ORN had an increased complications rate (34.6% vs. 3.8%).
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Table 1.
Comparison of parameters between obese and non-obese patients according to operative method
|
Open |
Laparoscopy |
|||||
|---|---|---|---|---|---|---|
| Non-obese (n=11) | Obese (n=15) | p-value | Non-obese (n=17) | Obese (n=13) | p-value | |
| Age | 55.6±13.6 | 55.8±9.6 | 0.960 | 54.3±15.4 | 58.1±10.3 | 0.452 |
| BMI (kg/m2) | 22.9±1.3 | 26.8±1.1 | 0.001a | 22.5±1.9 | 27.7±2.4 | 0.001a |
| Tumor size (mm) | 40.6±27.6 | 48.0±34.1 | 0.560 | 39.5±23.6 | 36.6±19.0 | 0.720 |
| Postoperative days | 8.3±0.9 | 8.4±1.5 | 0.721 | 6.9±2.0 | 7.3±2.2 | 0.711 |
| EBL (ml) | 348.2±187.3 | 446.7±222.4 | 0.217 | 184.1±116.3 | 143.0±62.7 | 0.390 |
| Transfusion rate (%) | 1 (3.8) | 8 (53.3) | 0.036a | 3 (17.6) | 0 (0) | 0.236 |
| Operation time (min) | 156.3±45.2 | 199.0±37.9 | 0.015a | 171.7±42.8 | 180.0±36.0 | 0.581 |
| Complication rate (%) | 1/11 (3.8) | 9/15 (34.6) | 0.014b | 3/17 (17.6) | 0/13 (0) | 0.236 |
Table 2.
Comparison of parameters between open and laparoscopic nephrectomy groups according to BMI
|
Non-obese (＜25 kg/m2) |
Obese (≥25 kg/m2) |
|||||
|---|---|---|---|---|---|---|
| Open (n=11) | Laparoscopy (n=17) | p-value | Open (n=15) | Laparoscopy (n=13) | p-value | |
| Age | 55.6±13.6 | 54.3±15.4 | 0.825 | 55.8±9.6 | 58.1±10.3 | 0.549 |
| BMI (kg/m2) | 22.9±1.3 | 22.5±1.9 | 0.558 | 26.8±1.1 | 27.7±2.4 | 0.247 |
| Tumor size (mm) | 40.6±27.6 | 39.5±23.6 | 0.911 | 48.0±34.1 | 36.6±19.0 | 0.295 |
| Postoperative days | 8.3±0.9 | 6.9±2.0 | 0.033a | 8.4±1.5 | 7.3±2.2 | 0.065 |
| EBL (ml) | 348.2±187.3 | 184.1±116.3 | 0.029a | 446.7±222.4 | 143.0±62.7 | 0.001a |
| Transfusion rate (%) | 1 (3.8) | 3 (17.6) | 1.000 | 8 (53.3) | 0 (0) | 0.002a |
| Operation time (min) | 156.3±45.2 | 171.7±42.8 | 0.371 | 199.0±37.9 | 180.0±36.0 | 0.188 |
| Complication rate (%) | 1/11 (3.8) | 3/17 (17.6) | 1.000 | 9/15 (60.0) | 0/13 (0) | 0.001b |
Table 3.
Characteristics of the open and laparoscopic nephrectomy groups
| Open | Laparoscopy | p-value | |
|---|---|---|---|
| No. of patients | 26 | 30 | |
| No. of men/women | 19/7 | 15/15 | 1.000 |
| Age | 55.7±11.2 | 56.0±13.4 | 0.419 |
| BMI (kg/m2) | 25.1±2.3 | 24.7±3.3 | 0.189 |
| Tumor size (mm) | 44.9±31.2 | 38.2±21.4 | 0.276 |
| Operation time (min) | 180.9±45.6 | 175.3±39.5 | 0.782 |
| EBL (ml) | 405.0±210.3 | 3 166.3±97.6 | 0.001a |
| Postoperative days | 8.4±1.2 | 7.1±2.0 | 0.002a |
| Complication rate (%) | 10 (38.4) | 3 (10.0) | 0.024a |
| Stage | T1 (n=22) | ) T1 (n=26) | 1.000 |
| T2 (n=4) | T2 (n=4) |
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