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Laparoscopic nephrectomy for kidney cancer associated with fewer ICU admissions, shorter hospitalizations
Tan HJ. Cancer. 2011;doi:10.1002/cncr.26014.
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Based on an evaluation of four primary outcomes, researchers concluded that laparoscopic nephrectomy provides “convalescence benefits” compared with open radical nephrectomy for patients being treated for kidney cancer.
Using linked data from the SEER database and the CMS, researchers identified 8,037 patients diagnosed with incident kidney cancer from 2000 to 2005. They selected that time frame because use of laparoscopic nephrectomy was widely adopted by the urologic community during that 5-year period.
Roughly three-quarters of patients in the study had undergone open radical nephrectomy, whereas the remaining patients underwent laparoscopic nephrectomy. Primary outcomes were ICU admission, length of hospitalization, 30-day hospital readmission and in-hospital mortality.
After adjusting for year of surgery and patient and tumor characteristics, researchers found that patients in the laparoscopic nephrectomy group were less likely to require ICU admission (OR=0.49; 95% CI, 0.43-0.55) or to have an extended hospitalization (OR=0.52; 95% CI, 0.42-0.64). Researchers said the probability for ICU admission was 41% for laparoscopic nephrectomy vs. 46% for open radical nephrectomy. Median length of stay was 4 days for laparoscopic nephrectomy vs. 5 days for open radical nephrectomy.
The likelihood of readmission did not differ significantly between the two groups (OR=1.05; 95% CI, 0.88-1.26). However, patients assigned to laparoscopic nephrectomy had a significantly higher risk of in-hospital mortality (OR=1.54; 95% CI, 1.02-2.32). Although researchers said in-hospital mortality was uncommon overall, patients in the laparoscopic nephrectomy group had a 51% greater chance of dying in the hospital.
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