ANZ journal of surgery · 2026
Evaluating Nephrectomy Outcomes in Regional Victoria: A Single-Centre Cohort Study.
СтатьяНазвание и аннотация: Перевод в очереди
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Sandhu Kieran, Hennes David, Flexmore Joe, Tiwari Samrath, O'Donnell Susannah, Naylor Keith, Hall Rohan
Аннотация
OBJECTIVE: Nephrectomy remains the cornerstone treatment for localised renal cancer (RC). The objective of this study was to assess outcomes of nephrectomy in a single regional centre.
METHODS: We conducted a retrospective cohort study of 114 patients undergoing nephrectomy with three surgeons at a regional referral centre between January 2019 and April 2024. Primary outcomes included operative time, ICU admission, and in-hospital mortality. Secondary outcomes included blood loss, post-operative complications, and preservation of renal function. Rurality was stratified according to the Modified Monash Model (MMM) rurality classification. Statistical analyses included chi-square, t-tests, Spearman correlation, and multivariate regression.
RESULTS: Of the cohort, 71.9% underwent laparoscopic and 28.1% underwent open nephrectomy. The open group had significantly longer operative time (217.5 vs. 180.0 min; p < 0.0001), higher blood loss (535.0 vs. 50.0 mL; p < 0.0002), and lower Day 1 post-op Hb (109.0 vs. 119.0 g/L; p = 0.03). On multivariate regression, blood loss (p = 0.03) and male gender (p = 0.03) independently predicted ICU admission. Age was the only significant predictor of post-op complications (p = 0.041). Pre-op eGFR predicted post-op renal function (p < 0.001), and open surgery was associated with lower Day 1 eGFR (p = 0.002). Rurality was not associated with worse outcomes.
CONCLUSION: Nephrectomy can be safely and effectively performed in regional centres, with outcomes comparable to metropolitan benchmarks. These findings support the provision of localised care for members of regional and rural communities.
METHODS: We conducted a retrospective cohort study of 114 patients undergoing nephrectomy with three surgeons at a regional referral centre between January 2019 and April 2024. Primary outcomes included operative time, ICU admission, and in-hospital mortality. Secondary outcomes included blood loss, post-operative complications, and preservation of renal function. Rurality was stratified according to the Modified Monash Model (MMM) rurality classification. Statistical analyses included chi-square, t-tests, Spearman correlation, and multivariate regression.
RESULTS: Of the cohort, 71.9% underwent laparoscopic and 28.1% underwent open nephrectomy. The open group had significantly longer operative time (217.5 vs. 180.0 min; p < 0.0001), higher blood loss (535.0 vs. 50.0 mL; p < 0.0002), and lower Day 1 post-op Hb (109.0 vs. 119.0 g/L; p = 0.03). On multivariate regression, blood loss (p = 0.03) and male gender (p = 0.03) independently predicted ICU admission. Age was the only significant predictor of post-op complications (p = 0.041). Pre-op eGFR predicted post-op renal function (p < 0.001), and open surgery was associated with lower Day 1 eGFR (p = 0.002). Rurality was not associated with worse outcomes.
CONCLUSION: Nephrectomy can be safely and effectively performed in regional centres, with outcomes comparable to metropolitan benchmarks. These findings support the provision of localised care for members of regional and rural communities.