The Benefit of Laparoscopic Partial Nephrectomy in High Body Mass Index Patients

Abstract

Objective: The aims of the present study were to evaluate the effect of body mass index on the surgical outcomes of open partial nephrectomy and laparoscopic partial nephrectomy, and to analyze whether higher body mass index patients may derive greater benefit from laparoscopic partial nephrectomy. Methods: We reviewed 110 patients who underwent open partial nephrectomy and 47 patients who underwent laparoscopic partial nephrectomy at our institution. We analyzed the data to determine what kind of factor would be associated with prolonged operative time, increased estimated blood loss and prolonged ischemic time, and compared the result of open partial nephrectomy with that of laparoscopic partial nephrectomy. Results: A statistically significant correlation was observed between body mass index and operative time or estimated blood loss in open partial nephrectomy. Multivariate analysis also demonstrated that body mass index was an independent predictor for prolonged operative time and higher estimated blood loss in open partial nephrectomy, but not in laparoscopic partial nephrectomy. In the normal body mass index group (body mass index , 25.0 kg/m 2 ), although mean operative time in the laparoscopic partial nephrectomy group was significantly longer than that in the open partial nephrectomy group, the difference was relatively small. In the high body mass index group (body mass index 25.0 kg/m 2 ), the mean operative time of the two groups was not statistically different. The estimated blood loss of open partial nephrectomy was significantly higher than that of laparoscopic partial nephrectomy in both groups. In both operative procedures, tumor size was an independent predictor for prolonged ischemic time in multivariate analysis. Conclusions: Body mass index was an independent predictor for prolonged operative time and higher estimated blood loss in open partial nephrectomy but not in laparoscopic partial nephrectomy. Laparoscopic partial nephrectomy was less influenced by body mass index and had a greater benefit, especially in high body mass index patients.

Laparoscopic renal surgery is here to stay

“…The functional and oncological outcomes are comparable between LPN and OPN. No differences were found in overall survival and progression-free survival rate between LPN and OPN [36] , [37] , [40] , [41] . In a matched-pair comparison, estimated GFR (eGFR) decline 24 h after surgery was significantly higher in LPN ( P < 0.001), but no decline was identified in a mean follow-up period of 3.6 years [40] .…”

“…Multiple series (mostly retrospective, none controlled) have compared open PN (OPN) with LPN; LPN was generally found to have a longer WIT [35] , [36] , [37] , [38] and operative time [36] , [39] , but a lower mean estimated blood loss when compared to OPN [35] , [36] , [37] . One retrospective study in Japan found that in patients who underwent LPN, high body mass index (BMI; ≥25 kg/m 2 ) did not confer longer operative time and higher estimated blood loss when compared to a normal BMI group, whilst patients who had OPN did, suggesting a possible benefit of LPN in patients with high BMIs [37] . Postoperative complications were generally reported to be similar in both groups [35] , [36] , [40] .…”

The BMI Paradox and Robotic Assisted Partial Nephrectomy

“…Our findings may not reflect other surgeons in other clinical settings. Furthermore, while this study's cohort size is larger than several recently published studies evaluating partial nephrectomy outcomes (33)(34)(35)(36), this study size is still too small to allow for a full detailed analysis of the complex relationship between BMI, tumor characteristics, and POC.…”

“…One such study specifically examining LPN concluded that high BMI was associated with increased risk of major complications in patients who underwent LPN (34). Others found BMI to be a predictor of poor surgical outcomes in open partial nephrectomies but not in LPN (35). This may be explained by the excess of perinephric fat that requires longer dissection during PN.…”

Feasibility of laparoscopic partial nephrectomy in the obese patient and assessment of predictors of perioperative outcomes

“…[ 5 6 7 8 9 10 ] However, only a limited number of studies exist examining the safety and efficacy of LPN in obese patients. [ 11 12 13 14 15 16 17 ] A 2012 meta-analysis concluded that LPN is safe and feasible in the obese population but that there was an increased risk of major complications. [ 11 ] A number of recent studies have also drawn similar conclusions regarding the feasibility of LPN.…”