Benefit of laparoscopic radical nephrectomy in patients with a high BMI.

OBJECTIVE The aim of the present study was to analyze all relevant data collected thus far at our hospital in order to compare the laparoscopic vs. open techniques in terms of the intraoperative results and to analyze whether patients with a higher BMI may derive greater benefit from laparoscopy. METHODS We reviewed the medical records of 93 patients treated with laparoscopic nephrectomy and 91 patients treated with the open method at our institution. We analyzed the data with the aim of determining what kind of factor would be associated with an increase in estimated blood loss and prolongation of operative time, and we compared the results for laparoscopic and open nephrectomy. RESULTS A statistically significant correlation was observed between body mass index and operating time (P = 0.018) or estimated blood loss (P = 0.017) in laparoscopic nephrectomy. Multivariate analysis demonstrated that body mass index was an independent risk factor for prolonged operating time (P = 0.030, odds ratio = 1.174). In the open nephrectomy patients, body mass index also had a significant correlation with operating time (P < 0.001) and estimated blood loss (P < 0.001). Multivariate analysis also revealed that operating time depended on body mass index (P < 0.001, odds ratio = 1.348) and tumor size (P = 0.030, odds ratio = 1.320), and the odds ratio of body mass index was higher than that in laparoscopic nephrectomy. CONCLUSIONS As body mass index increases, both laparoscopic nephrectomy and open nephrectomy become technically more difficult. However, our data showed that for patients with a high body mass index, the laparoscopic approach is comparatively safer and of greater benefit.