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28.10.2015 | Original Article

Postoperative drainage does not prevent complications after robotic partial nephrectomy

verfasst von: Benoit Peyronnet, Benjamin Pradère, Alexandre De La Taille, Franck Bruyère, Nicolas Doumerc, Stéphane Droupy, Christophe Vaessen, Hervé Baumert, Jean-Christophe Bernhard, Morgan Rouprêt, Arnaud Mejean, Karim Bensalah

Erschienen in: World Journal of Urology | Ausgabe 7/2016

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Abstract

Objectives

We aimed to assess the impact of a postoperative drainage after RPN.

Methods

A retrospective multicentric study included RPN performed at eight centers between 2010 and 2014. Three centers stopped using postoperative drainage early in their RPN experience, whereas other institutions systematically left a drain. Preoperative characteristics, complication rates, need for postoperative imaging or procedure (surgical or radiological) and length of hospital stay were compared between the two groups [drainage (D) and no drainage (ND)].

Results

Among 636 RPNs, 140 were done without drainage (22 %). In the ND group, surgeons were more experienced (>50 cases: 55.7 vs. 15.1 %; p < 0.0001), and tumors were more complex (RENAL score: 7.6 vs. 6.5; p < 0.0001). Complication rates were similar in both groups (21.9 vs. 20.2 %; p = 0.67). The omission of postoperative drainage did not increase requirement of CT scan (RR = 1.03; 95 % CI 0.64–1.67). Length of hospital stay was shorter in the ND group (4.5 vs. 5.5 days; p = 0.007). There were six urinary fistulas: four in the D group (0.8 %) and two in the ND group (1.4 %; p = 0.49). A CT scan was done to confirm the diagnosis of fistula in every case. In multivariate analysis, the omission of drainage was not associated with increased need of postoperative CT scan or major complications but was a predictor of decreased length of stay.

Conclusion

The omission of postoperative drainage does not seem to increase the risk of postoperative complications and could safely be omitted after RPN.
Literatur
2.
Zurück zum Zitat Gill IS, Kavoussi LR, Lane BR et al (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46CrossRefPubMed Gill IS, Kavoussi LR, Lane BR et al (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46CrossRefPubMed
3.
Zurück zum Zitat Kim JH, Park YH, Kim YJ et al (2015) Perioperative and long-term renal functional outcomes of robotic versus laparoscopic partial nephrectomy: a multicenter matched-pair comparison. World J Urol 33:1579–1584CrossRefPubMed Kim JH, Park YH, Kim YJ et al (2015) Perioperative and long-term renal functional outcomes of robotic versus laparoscopic partial nephrectomy: a multicenter matched-pair comparison. World J Urol 33:1579–1584CrossRefPubMed
4.
Zurück zum Zitat Van Poppel H, DaPozzo L, Albrecht W et al (2007) A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal carcinoma. Eur Urol 51:1606–1615CrossRefPubMed Van Poppel H, DaPozzo L, Albrecht W et al (2007) A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal carcinoma. Eur Urol 51:1606–1615CrossRefPubMed
5.
Zurück zum Zitat Stephenson AJ, Hakimi AA, Snyder ME et al (2004) Complications of radical and partial nephrectomy in a large contemporary cohort. J Urol 171:130–134CrossRefPubMed Stephenson AJ, Hakimi AA, Snyder ME et al (2004) Complications of radical and partial nephrectomy in a large contemporary cohort. J Urol 171:130–134CrossRefPubMed
6.
Zurück zum Zitat Poon SA, Silberstein JL, Chen LY et al (2013) Trends in partial and radical nephrectomy: an analysis of case logs from certifying urologists. J Urol 190(2):464–469CrossRefPubMedPubMedCentral Poon SA, Silberstein JL, Chen LY et al (2013) Trends in partial and radical nephrectomy: an analysis of case logs from certifying urologists. J Urol 190(2):464–469CrossRefPubMedPubMedCentral
7.
8.
Zurück zum Zitat Sánchez-Ortiz R, Madsen LT, Swanson DA et al (2004) Closed suction or penrose drainage after partial nephrectomy: does it matter? J Urol 171(1):244–246CrossRefPubMed Sánchez-Ortiz R, Madsen LT, Swanson DA et al (2004) Closed suction or penrose drainage after partial nephrectomy: does it matter? J Urol 171(1):244–246CrossRefPubMed
9.
Zurück zum Zitat Park JS, Kim JH, Kim JK et al (2015) The role of abdominal drainage to prevent of intra-abdominal complications after laparoscopic cholecystectomy for acute cholecystitis: prospective randomized trial. Surg Endosc 29(2):453–457CrossRefPubMed Park JS, Kim JH, Kim JK et al (2015) The role of abdominal drainage to prevent of intra-abdominal complications after laparoscopic cholecystectomy for acute cholecystitis: prospective randomized trial. Surg Endosc 29(2):453–457CrossRefPubMed
10.
Zurück zum Zitat Rondelli F, Desio M, Vedovati MC et al (2014) Intra-abdominal drainage after pancreatic resection: is it really necessary? A meta-analysis of short-term outcomes. Int J Surg 12(Suppl 1):S40–S47CrossRefPubMed Rondelli F, Desio M, Vedovati MC et al (2014) Intra-abdominal drainage after pancreatic resection: is it really necessary? A meta-analysis of short-term outcomes. Int J Surg 12(Suppl 1):S40–S47CrossRefPubMed
11.
Zurück zum Zitat Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853CrossRefPubMed Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853CrossRefPubMed
12.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral
13.
14.
Zurück zum Zitat Petrowsky H, Demartines N, Rousson V, Clavien PA (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 240(6):1074–1084CrossRefPubMedPubMedCentral Petrowsky H, Demartines N, Rousson V, Clavien PA (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 240(6):1074–1084CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Clements T, Raman JD (2011) Surgery: is perinephric drainage essential after partial nephrectomy? Nat Rev Urol 8(11):594–595CrossRefPubMed Clements T, Raman JD (2011) Surgery: is perinephric drainage essential after partial nephrectomy? Nat Rev Urol 8(11):594–595CrossRefPubMed
16.
Zurück zum Zitat Godoy G, Katz DJ, Adamy A, Jamal JE, Bernstein M, Russo P (2011) Routine drain placement after partial nephrectomy is not always necessary. J Urol 186(2):411–415CrossRefPubMed Godoy G, Katz DJ, Adamy A, Jamal JE, Bernstein M, Russo P (2011) Routine drain placement after partial nephrectomy is not always necessary. J Urol 186(2):411–415CrossRefPubMed
17.
Zurück zum Zitat Abaza R, Prall D (2013) Drain placement can be safely omitted after the majority of robotic partial nephrectomies. J Urol 189(3):823–827CrossRefPubMed Abaza R, Prall D (2013) Drain placement can be safely omitted after the majority of robotic partial nephrectomies. J Urol 189(3):823–827CrossRefPubMed
18.
Zurück zum Zitat Campbell SC, Novick AC, Streem SB, Klein E, Licht M (1994) Complications of nephron sparing surgery for renal tumors. J Urol 151(5):1177–1180PubMed Campbell SC, Novick AC, Streem SB, Klein E, Licht M (1994) Complications of nephron sparing surgery for renal tumors. J Urol 151(5):1177–1180PubMed
19.
Zurück zum Zitat Meeks JJ, Zhao LC, Navai N, Perry KT Jr, Nadler RB, Smith ND (2008) Risk factors and management of urine leaks after partial nephrectomy. J Urol 180(6):2375–2378CrossRefPubMed Meeks JJ, Zhao LC, Navai N, Perry KT Jr, Nadler RB, Smith ND (2008) Risk factors and management of urine leaks after partial nephrectomy. J Urol 180(6):2375–2378CrossRefPubMed
20.
Zurück zum Zitat Sarwani NI, Motta Ramirez GA, Remer EM, Kaouk JH, Gill IS (2007) Imaging findings after minimally invasive nephron-sparing renal therapies. Clin Radiol 62(4):333–339CrossRefPubMed Sarwani NI, Motta Ramirez GA, Remer EM, Kaouk JH, Gill IS (2007) Imaging findings after minimally invasive nephron-sparing renal therapies. Clin Radiol 62(4):333–339CrossRefPubMed
21.
Zurück zum Zitat Schein M (2008) To drain or not to drain? The role of drainage in the contaminated and infected abdomen: an international and personal perspective. World J Surg 32(2):312–321CrossRefPubMed Schein M (2008) To drain or not to drain? The role of drainage in the contaminated and infected abdomen: an international and personal perspective. World J Surg 32(2):312–321CrossRefPubMed
Metadaten
Titel
Postoperative drainage does not prevent complications after robotic partial nephrectomy
verfasst von
Benoit Peyronnet
Benjamin Pradère
Alexandre De La Taille
Franck Bruyère
Nicolas Doumerc
Stéphane Droupy
Christophe Vaessen
Hervé Baumert
Jean-Christophe Bernhard
Morgan Rouprêt
Arnaud Mejean
Karim Bensalah
Publikationsdatum
28.10.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
World Journal of Urology / Ausgabe 7/2016
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-015-1721-2

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