2008 Annual Meeting Abstracts
The Impact of Body Mass Index on Outcomes in Partial Nephrectomies for Renal Cell Cancer
Charles Dolce, William DeVoe, H. James Norton, David Iannitti, B. Todd Heniford, Chris Teigland, Kent Kercher.
Carolinas Medical Center, Charlotte, NC, USA.
Objectives: To evaluate the clinical outcomes of partial nephrectomies (PN) performed for RCC in the obese patient.
Design: Retrospective review of prospectively collected data.
Setting: Tertiary Care Center
Patients: All patients who underwent partial nephrectomy from July 2000 to December 2007. Patients were divided into two groups based on body mass index (BMI) ≥ or <30.
Intervention: Partial nephrectomy for Renal Cell Cancer
Main Outcome Measures: Estimated blood loss (EBL), operative time, length of hospital stay (LOS), postoperative complications, tumor size, tumor nuclear grade.
Results: PN was performed in 73 patients during the study period. Nine patients were excluded from the study due to non-RCC pathology and one patient was excluded due to lack of BMI data. Of the remaining 63 patients, 19 were obese. Fifty hand-assisted laparoscopic partial nephrectomies (HALPN) and 13 open-PN were performed. The mean length of follow-up was 702 days (range 5-2631). There were no differences in tumor size (2.81 vs.2.87cm, p=0.91) or tumor nuclear grade (p=0.72) between groups. There were no significant differences in EBL (172 vs.169ml, p=0.95), operative time (153 vs.160minutes, p=0.61), LOS (5.4 vs.5.3 days, p=0.79) or postoperative complications (p=0.53). Among obese patients, HALPN had less EBL (126.7 vs.359.2ml, p<0.0001) and operative time (145.6 vs.203.0min, p<0.02) than open-PNs. One obese patient underwent cryoablation of a recurrence from a T3a tumor and one nonobese patient diagnosed with metastatic disease died 3 years after surgery.
Conclusions: HALPN and open-PNs can be safely performed in obese patients for small organ-confined RCC. Perioperative outcomes and complication rates were similar between obese and nonobese groups. In addition, no difference was seen in tumor biology, recurrence, or survival in obese patients.