Category: Clinical Oncology: Outcomes & Complications

MP23-9 - What factors affect post-operative outcomes in patients undergoing laparoscopic upper tract surgery? Results from a UK regional cancer center

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Minimal access surgery combined with the use of enhanced recovery after surgery facilitate an accelerated post-operative recovery in patients undergoing major abdominal surgery. However, other variables may yet influence post-operative recovery, including patient or non-patient related factors. The aim of this study is to determine which factors predict post-operative length of stay (LoS) in patients undergoing laparoscopic upper urinary tract surgery.


Methods :

Prospective data from the BAUS nephrectomy database was evaluated on patients who underwent laparoscopic partial, simple and radical nephrectomy and nephroureterectomy between March 2016 and March 2018. Statistical analysis including multivariate linear regression was performed to determine whether specific variables influenced LoS such as age, sex, BMI, Charlson Comorbidity Index (CCI), lesion size and ischaemia time. Open procedures were excluded. All patients were managed using an enhanced recovery approach post-operatively.


Results :

Overall 139 operations were performed including 72 radical, 13 simple and 45 partial nephrectomies and 9 nephroureterectomies.  Mean age was 61.9 years and 63.4% of patients were male. A retroperitoneal approach was carried out in 97.9% of cases.  The overall mean LoS was 2.9 days and complication rate was 10.8% (80% of which were Clavien Dindo 1). In patients undergoing partial nephrectomy, female sex and a larger lesion size were found to be associated with an increased LoS (p=0.043 and p=0.001, respectively). There was no significant difference with age, BMI, CCI, ischaemia time or location of tumour (anterior versus posterior). In patients undergoing radical and simple nephrectomy and nephroureterectomy, only increased age was associated with an increased LoS (p=0.007).


Conclusions :

Laparoscopic retroperitoneal surgery is associated with a low complication rate and length of stay. In this study, lesion size and female sex were associated with an increased loS in patients undergoing partial nephrectomy, whereas only increased age was associated with an increased LoS in patients undergoing radical and simple nephrectomy and nephroureterectomy. This may be useful when counseling patients pre-operatively. Larger multi-center studies are needed to confirm these results.

Michael Wanis

Urology Speciality Trainee
Brighton And sussex University Hospitals
Hayward's Heath, England, United Kingdom

Ammar Alanbuki

Hayward's Heath, England, United Kingdom

Tim Larner

Consultant Urologist
Brighton & Sussex University NHS Foundation Trust
Hayward's Heath, England, United Kingdom