Abstract：
OBJECTIVE: Simple nephrectomies can be challenging with significant morbidity. To prove the hypothesis of \"not-so-simple\" nephrectomy, we compared demographics, perioperative outcomes, and complications between simple and radical nephrectomy in a tertiary referral center.
METHODS: We analyzed 473 consecutive radical nephrectomies (January 2018-October 2020) and simple nephrectomies (January 2016-October 2020). Univariate and multivariate analysis of perioperative outcomes utilized the Mann-Whitney U test, Chi-squared test, Mantel-Haenszel test of trend, and multiple linear regression. Radical nephrectomies were classified in cT1, cT2a, and cT2b-T3 subgroups and compared to simple nephrectomies. Minimally invasive and open techniques were compared between the two groups. Infected versus non-infected simple nephrectomies were compared.
RESULTS: A total of 344 radical and 129 simple nephrectomies were included. Simple nephrectomy was an independent predictor of increased operative time (p = 0.001), length of stay (p = 0.049), and postoperative complications (p < 0.001). Simple nephrectomies had higher operative time (p < 0.001), length of stay (p = 0.014), and postoperative morbidity (p < 0.001) than cT1 radical nephrectomies and significantly more Clavien 1-2 complications than cT2a radical nephrectomies (p = 0.001). The trend was similar in minimally invasive operations. However, conversion to open rates was not significantly different. Infected simple nephrectomies had increased operative time (p < 0.001), length of stay (p = 0.005), blood loss (p = 0.016), and intensive care stay (p = 0.019).
CONCLUSIONS: Patients undergoing simple nephrectomy experienced increased operative time and morbidity. Simple nephrectomy carries higher morbidity than radical nephrectomy in tumors ≤10 cm. Robotic simple nephrectomies may reduce open conversion rates. Postoperative intensive care and enhanced recovery may be essential in simple nephrectomy planning with infected pathology.
METHODS: We analyzed 473 consecutive radical nephrectomies (January 2018-October 2020) and simple nephrectomies (January 2016-October 2020). Univariate and multivariate analysis of perioperative outcomes utilized the Mann-Whitney U test, Chi-squared test, Mantel-Haenszel test of trend, and multiple linear regression. Radical nephrectomies were classified in cT1, cT2a, and cT2b-T3 subgroups and compared to simple nephrectomies. Minimally invasive and open techniques were compared between the two groups. Infected versus non-infected simple nephrectomies were compared.
RESULTS: A total of 344 radical and 129 simple nephrectomies were included. Simple nephrectomy was an independent predictor of increased operative time (p = 0.001), length of stay (p = 0.049), and postoperative complications (p < 0.001). Simple nephrectomies had higher operative time (p < 0.001), length of stay (p = 0.014), and postoperative morbidity (p < 0.001) than cT1 radical nephrectomies and significantly more Clavien 1-2 complications than cT2a radical nephrectomies (p = 0.001). The trend was similar in minimally invasive operations. However, conversion to open rates was not significantly different. Infected simple nephrectomies had increased operative time (p < 0.001), length of stay (p = 0.005), blood loss (p = 0.016), and intensive care stay (p = 0.019).
CONCLUSIONS: Patients undergoing simple nephrectomy experienced increased operative time and morbidity. Simple nephrectomy carries higher morbidity than radical nephrectomy in tumors ≤10 cm. Robotic simple nephrectomies may reduce open conversion rates. Postoperative intensive care and enhanced recovery may be essential in simple nephrectomy planning with infected pathology.
摘要：
目的：单纯肾切除术可能具有挑战性，具有显著的发病率。为了证明“不那么简单”的肾切除术的假设，我们比较了人口统计，围手术期结局,以及三级转诊中心单纯肾切除术和根治性肾切除术之间的并发症。
方法：我们分析了473例连续根治性肾切除术（2018年1月至2020年10月）和单纯肾切除术（2016年1月至2020年10月）。围手术期结局的单因素和多因素分析采用Mann-WhitneyU检验，卡方检验,Mantel-Haenszel趋势测试，和多元线性回归。根治性肾切除术分为cT1、cT2a、和cT2b-T3亚组，并与单纯肾切除术进行比较。比较两组患者的微创和开放技术。比较了感染和未感染的简单肾切除术。
结果：共包括344例根治性肾切除术和129例单纯性肾切除术。单纯肾切除术是增加手术时间的独立预测因素（p=0.001）。停留时间（p=0.049），术后并发症（p<0.001）。单纯肾切除术的手术时间更长（p<0.001），停留时间（p=0.014），术后发病率（p<0.001）高于cT1根治性肾切除术，Clavien1-2并发症明显高于cT2a根治性肾切除术（p=0.001）。在微创手术中趋势相似。然而,转化率没有显著差异.感染的单纯肾切除术增加了手术时间（p<0.001），停留时间（p=0.005），失血量（p=0.016），和重症监护住院(p=0.019)。
结论：接受单纯肾切除术的患者的手术时间和发病率增加。在≤10cm的肿瘤中，单纯肾切除术的发病率高于根治性肾切除术。机器人简单肾切除术可能会降低开放转化率。在感染病理的简单肾切除术计划中，术后重症监护和增强康复可能是必不可少的。
方法：我们分析了473例连续根治性肾切除术（2018年1月至2020年10月）和单纯肾切除术（2016年1月至2020年10月）。围手术期结局的单因素和多因素分析采用Mann-WhitneyU检验，卡方检验,Mantel-Haenszel趋势测试，和多元线性回归。根治性肾切除术分为cT1、cT2a、和cT2b-T3亚组，并与单纯肾切除术进行比较。比较两组患者的微创和开放技术。比较了感染和未感染的简单肾切除术。
结果：共包括344例根治性肾切除术和129例单纯性肾切除术。单纯肾切除术是增加手术时间的独立预测因素（p=0.001）。停留时间（p=0.049），术后并发症（p<0.001）。单纯肾切除术的手术时间更长（p<0.001），停留时间（p=0.014），术后发病率（p<0.001）高于cT1根治性肾切除术，Clavien1-2并发症明显高于cT2a根治性肾切除术（p=0.001）。在微创手术中趋势相似。然而,转化率没有显著差异.感染的单纯肾切除术增加了手术时间（p<0.001），停留时间（p=0.005），失血量（p=0.016），和重症监护住院(p=0.019)。
结论：接受单纯肾切除术的患者的手术时间和发病率增加。在≤10cm的肿瘤中，单纯肾切除术的发病率高于根治性肾切除术。机器人简单肾切除术可能会降低开放转化率。在感染病理的简单肾切除术计划中，术后重症监护和增强康复可能是必不可少的。
