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  • Title: Propensity-score-matched comparison of perioperative outcomes between open and laparoscopic nephroureterectomy: a national series.
    Author: Hanna N, Sun M, Trinh QD, Hansen J, Bianchi M, Montorsi F, Shariat SF, Graefen M, Perrotte P, Karakiewicz PI.
    Journal: Eur Urol; 2012 Apr; 61(4):715-21. PubMed ID: 22209172.
    Abstract:
    BACKGROUND: Nephroureterectomy (NU) represents the primary management for patients with nonmetastatic upper tract urothelial carcinoma (UTUC). Either an open NU (ONU) or a laparoscopic NU (LNU) may be considered. Despite the presence of several reports comparing perioperative and cancer-control outcomes between the two approaches, no reports relied on a population-based cohort. OBJECTIVES: Examine intraoperative and postoperative morbidity of ONU and LNU in a population-based cohort. DESIGN, SETTING, AND PARTICIPANTS: We relied on the US Nationwide Inpatient Sample (NIS) to identify patients with nonmetastatic UTUC treated with ONU or LNU between 1998 and 2009. Overall, 7401 (90.8%) and 754 (9.2%) patients underwent ONU and LNU, respectively. To adjust for potential baseline differences between the two groups, propensity-score-based matching was performed. This resulted in 3016 (80%) ONU patients matched to 754 (20%) LNU patients. INTERVENTION: All patients underwent NU. MEASUREMENTS: The rates of intra- and postoperative complications, blood transfusions, prolonged length of stay (pLOS), and in-hospital mortality were assessed for both procedures. Multivariable logistic regression analyses were performed within the cohort after propensity-score matching. RESULTS AND LIMITATIONS: For ONU versus LNU respectively, the following rates were recorded: blood transfusions, 15% versus 10% (p<0.001); intraoperative complications, 4.7% versus 2.1% (p=0.002); postoperative complications, 17% versus 15% (p=0.24); pLOS (≥5 d), 47% versus 28% (p<0.001); in-hospital mortality, 1.3% versus 0.7% (p=0.12). In multivariable logistic regression analyses, LNU patients were less likely to receive a blood transfusion (odds ratio [OR]: 0.6; p<0.001), to experience any intraoperative complications (OR: 0.4; p=0.002), and to have a pLOS (OR: 0.4; p<0.001). Overall, postoperative complications were equivalent. However, LNU patients had fewer respiratory complications (OR: 0.4; p=0.007). This study is limited by its retrospective nature. CONCLUSIONS: After adjustment for potential selection biases, LNU is associated with fewer adverse intra- and perioperative outcomes than ONU.
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