Complications of radical nephrectomy and partial nephrectomy: What are they? How can they be anticipated and managed?

被引:4
|
作者
Bensalah, K. [1 ]
Pignot, G. [2 ]
Legeais, D. [3 ]
Madec, F. -x. [4 ]
Lebacle, C. [6 ]
Doizi, S. [5 ]
Phe, V. [5 ]
Mathieu, R. [1 ]
Irani, J. [6 ]
机构
[1] Univ Rennes 1, Serv Urol, F-35000 Rennes, France
[2] Inst Paoli Calmettes, Serv Chirurg Oncol 2, F-13009 Marseille, France
[3] Clin Alembert, F-38000 Grenoble, France
[4] Univ Versailles St Quentin En Yvelines, Hop Foch, Serv Urol, F-92150 Suresnes, France
[5] Univ Paris Saclay, Hop Bicetre, AP HP, Serv Urol, F-94270 Le Kremlin Bicetre, France
[6] Sorbonne Univ, Hop Tenon, AP HP, Serv Urol, F-75020 Paris, France
来源
PROGRES EN UROLOGIE | 2022年 / 32卷 / 14期
关键词
Complications; Partial nephrectomy; Total nephrectomy; Renal surgery; RENAL-ARTERY PSEUDOANEURYSM; CYTOREDUCTIVE NEPHRECTOMY; HEMORRHAGIC COMPLICATIONS; PERIOPERATIVE OUTCOMES; CELL CARCINOMA; TUMORS; MORBIDITY; SURGERY; IMPACT; FAT;
D O I
10.1016/j.purol.2022.09.011
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction. - Surgical techniques of radical and partial nephrectomy have changed over the last 20 years. Indications for partial nephrectomy have widened and mini-invasive surgery (lapa-roscopy and robotic assistance) has become widely used. However, both still have a significant morbidity. The objective of this article is to review complications of renal surgery and their predictive factors and to offer algorithms of management.Methods. - Recent literature regarding complications of radical and partial nephrectomy was queried using Pubmed engine search. The most relevant articles were analyzed and served as a basis for this work.Results. - The literature on complications of radical and partial nephrectomy has a low level of evidence. There are only retrospective series. The most frequent complications of radical nephrectomy occur during surgery in 5-10% of the cases: wound of the pedicle or of an adja-cent organ. The management can often be conservative. Laparoscopy has a similar morbidity compare to the open approach but has greatly increased postoperative outcomes and comfort. Partial nephrectomy has a 20% complication rate. Many factors have an impact on the risk of complications (tumor size, inflammation of perirenal fat, access, surgeon experience, centre volume, comorbidities and age of the patient) and must be taken into consideration before advising partial nephrectomy. The two most feared complications of partial nephrectomy are bleeding (per-or postoperative, 10% of the cases) and urinary fistula (< 5% of the cases). Robotic assistance is associated with a lower morbidity in many publications.Conclusion. - Complications after partial and radical nephrectomy are quite frequent but have decreased with the improvement of surgical techniques. French urologists should maintain their interest in novel technologies and simplification of perioperative pathway to further improve patients' outcomes.(c) 2022 Published by Elsevier Masson SAS.
引用
收藏
页码:928 / 939
页数:12
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