Gozen Ali Serdar, Gherman Vitalie, Akin Yigit, Bolat Mustafa Suat, Elmussareh Muhammad, Rassweiler Jens
Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany.
Arch Ital Urol Androl. 2017 Dec 31;89(4):266-271. doi: 10.4081/aiua.2017.4.266.
To provide a standardised report of complications after retroperitoneal laparoscopic radical nephrectomy (rLRN) in a high-volume centre using Clavien-Dindo classification.
We analysed records maintained in a prospective database of 330 consecutive patients that underwent rLRN between March 1995 and September 2016. All complications were graded according to the modified Clavien-Dindo classification. Three generations of surgeons were defined and the learning curve in rLRN was evaluated by comparing the first 100 cases (Group A) performed by firstgeneration surgeons with the last 100 cases (Group B) by thirdgeneration surgeons.
The mean age of our cohort was 66 ± 11.9 years. The overall complication rate was 19.7%. The majority of complications (12.7%) were Clavien 1 (5.1%) and Clavien 2 (7.6%) and did not require any interventions; blood transfusion was the most frequently encountered intervention (4.8%). Half of which were because of major intraoperative bleeding. Mortality rate was 0.9%. We found a trend towards lower complication rate in group B (19%) compared to group A (23%); this was mainly because of the reduction in the incidence of Clavien 1 and 2 complications. The pathological stage varied significantly in the two groups while the rate of negative surgical margins was comparable.
rLRN is a safe procedure with an acceptable rate of complications. The learning curve was shorter for the thirdgeneration surgeons (group B); although these surgeons operated on a significantly higher number of patients with more advanced diseases. The Clavien-Dindo classification is suitable for assessing rLRN complications. Adopting this standardised system can help in the evaluation and comparison of surgical quality of LRN series.
使用Clavien-Dindo分类法，在一个高容量中心提供腹膜后腹腔镜根治性肾切除术（rLRN）后并发症的标准化报告。
我们分析了1995年3月至2016年9月期间连续330例行rLRN患者的前瞻性数据库记录。所有并发症均根据改良的Clavien-Dindo分类法进行分级。定义了三代外科医生，并通过比较第一代外科医生完成的前100例病例（A组）和第三代外科医生完成的后100例病例（B组）来评估rLRN的学习曲线。
我们队列的平均年龄为66±11.9岁。总体并发症发生率为19.7%。大多数并发症（12.7%）为Clavien 1级（5.1%）和Clavien 2级（7.6%），无需任何干预；输血是最常见的干预措施（4.8%）。其中一半是由于术中大出血。死亡率为0.9%。我们发现B组（19%）的并发症发生率有低于A组（23%）的趋势；这主要是因为Clavien 1级和2级并发症的发生率降低。两组的病理分期差异显著，而手术切缘阴性率相当。
rLRN是一种安全的手术，并发症发生率可接受。第三代外科医生（B组）的学习曲线较短；尽管这些外科医生手术的患者数量明显更多，且疾病更晚期。Clavien-Dindo分类法适用于评估rLRN并发症。采用这种标准化系统有助于评估和比较LRN系列的手术质量。
