Laparoskopik vs Açık Nefron Koruyucu Cerrahide Yaşam Kalitesi
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The aim of this study is to prospectively evaluate the effect of surgery on quality of life in patients undergone laparoscopic nephron sparing surgery (LNSS) versus open nephron sparing surgery (ONSS) for small renal masses. Between December 2007 - December 2011, 65 patients (M/F = 37/28) underwent nephron sparing surgery (open/laparoscopic = 45/20) for small renal masses. Patients demographic data, body mass index, American Society of Anesthesiologists (ASA) score, renal mass characteristics were registered preoperatively and patients were divided in 2 groups; the 1st group (LNSS) and the 2nd group (ONSS), respectively. Quality of life was evaluated prospectively using SF-36 health survey pre- and post-operatively (1, 6 and 12 months after surgery). Postoperative pain was evaluated 48 hours after surgery using VAS pain score. Per- and post-operative complications, oral feeding time, drain removal time and hospital stay were also registered. Patients mean age, BMI and ASA score was 53.78 (17-87) years, 28.52 (20.3-45.7) and 1.39 (0-3), respectively. Renal masses were right-sided in 28, left-sided in 26 patients; mean size was 26.4 mm in LNSS and 31.6 mm in the ONSS group (P=0,244). Mean operative time and blood loss was 137.19 min and 55.26 cc in the LNSS group; 133.4 min (P=0,778) and 202.8 cc (P=0,037) in the ONSS group. No peroperative complication observed in the LNSS group; in the ONSS group 1 patient underwent splenectomy due to peroperative lasseration. Postoperative VAS score in the LNSS and ONSS group was 2.81 and 4.9 (P=0.002), respectively. Oral feding time, drain removal time and hospital stay was 15.71 hrs, 1.94 days, 2.95 days in the LNSS group and 24 hrs (P=0,002), 2.72 days (P=0,003), 5.25 days (P=0,000) in the ONSS one. Pre- and postoperative SF-36 health survey scores in both groups are shown in Table 1. One postoperative complication was observed in the LNSS group and three complications in the ONSS one. Open radical nephrectomy was performed in one LNSS patient due to wide positive surgical margin. In the ONSS group: one patient had wound infection, percutaneous dreinage catheter was placed in two other patients for intraabdominal abces, thereafter one of them showed no progress and underwent surgical exploration and simple nephrectomy thereby.