Complications and renal functional deterioration in patients with co-morbidities following laparoscopic partial nephrectomy

Objectives: To study the incidence of complications and the association between preoperative co morbidities and follow up renal function following laparoscopic partial nephrectomy. Subjects and methods: After due approval from a local ethical committee, retrospective analysis of the records of 68 consecutive laparoscopic partial nephrectomies was performed for renal malignancy during the decade (2005–2015). The data acquisition was done with regard to the demographic data, Charlson co-morbidity score, and perioperative complications using modified Clavian-Dindo scale, margin positivity status, disease free survival and postoperative eGFR using CKD-EPI equation. Results: The cohort consisted of 63 males and 5 females with a mean age of 51 years (3rd to 8th decade). The tumor size varied from 1 to 7 cm with a mean of 3.8 cm. The follow up was available for a period ranging from 3 months to 180 months with a mean of 40.7 months. There were a total of 14 complications in 12 patients. The overall complication rate in our series was 20.58%, majority 10 (14.70%) being minor complications (grades 1 & 2); there were 3 (4.41%) grade 3a complication and one (1.47%) grade 3b complication. The co-morbidities were assessed with Charlson Co-morbidity score (CCS) and the relation between CCS and follow up eGFR values was also assessed. There was a statistically significant association between the CCS and follow up eGFR, the deterioration being highest in those eight patients with CCS of 6 & 7; the lowest being in those with low CCS. Conclusion: Laparoscopic partial nephrectomy for renal malignancy is safe surgery with low complication rate and there is a definite association between the preoperative co-morbidities and renal functional deterioration postoperatively