Impact of Host Factors on Robotic Partial Nephrectomy Outcomes: Comprehensive Systematic Review and Meta-Analysis

Cacciamani, Giovanni; Gill, Tania; Medina, Luis G.; Ashrafi, Akbar; Winter, Matthew; Sotelo, René; Artibani, Walter; Gill, Inderbir S.

doi:10.1016/j.juro.2018.04.079

Cited by 43 publications

(40 citation statements)

References 47 publications

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“…Conversely, the SPARE system was not an independent predictor of renal function impairment. These data concur with other studies showing that the original PADUA score was not a predictor of 3-month renal function impairment [5,23]. Therefore, tumour CSA could help surgeons to tailor Limitations of the present study include the retrospective design and the lack of central imaging review to assign the variables included in the PADUA score and to calculate the tumour CSA.…”

Section: Discussionsupporting

confidence: 86%

The Simplified PADUA REnal (SPARE) nephrometry system: a novel classification of parenchymal renal tumours suitable for partial nephrectomy

et al. 2019

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Objective To simplify the original Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classification of renal tumours, generating a new system able to predict equally or better the risk of overall complications in patients undergoing partial nephrectomy (PN); and to test if the addition of the contact surface area (CSA) parameter improves the accuracy of the original PADUA and new Simplified PADUA REnal (SPARE) nephrometry classification systems. Patients and Methods We analysed the clinical records of 531 patients who underwent PN (open, laparoscopic and robot‐assisted) for renal tumours at five tertiary academic referral centres from January 2014 to December 2016. The ability of each variable included in the PADUA classification to predict overall complications was tested using binary logistic regression analysis. The variables that were not statistically significant were excluded from the SPARE classification. In addition to the original PADUA and SPARE systems, another two models were generated adding tumour CSA. Receiver operating characteristic curve analysis was used to compare the ability of the four different models to predict overall complications. Binary logistic regression was used to perform both univariable and multivariable analyses looking for predictors of postoperative complications. Linear regression analysis was used to identify independent predictors of absolute change in estimated glomerular filtration rate (eGFR; ACE). Results The SPARE nephrometry score system including: (i) rim location, (ii) renal sinus involvement, (iii) exophytic rate, and (iv) tumour dimension; showed equal performance in comparison with the original PADUA score (area under the curve [AUC] 0.657 vs 0.664). Adding tumour CSA to the original PADUA (AUC 0.661) or to the SPARE (AUC 0.658) scores did not increase the accuracy of either system to predict overall complications. The SPARE system (odds ratio 1.2, 95% confidence interval 1.1–1.3) was an independent predictor of postoperative overall complications. Age (P < 0.001), body mass index (P < 0.001), Charlson Comorbidity Index (P = 0.02), preoperative eGFR (P < 0.001), and tumour CSA (P = 0.005) were independent predictors of ACE. Limitations include the retrospective design and the lack of central imaging review. Conclusions The new SPARE score is comprised of only four variables instead of the original six and its accuracy to predict overall complications is similar to that of the original PADUA score. Addition of tumour CSA was not associated with an increase in prognostic accuracy. The SPARE system could replace the original PADUA score to evaluate the complexity of tumours suitable for PN.

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Section: Discussionsupporting

confidence: 86%

The Simplified PADUA REnal (SPARE) nephrometry system: a novel classification of parenchymal renal tumours suitable for partial nephrectomy

et al. 2019

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“…With regard to the clinical implications of these findings, and specifically the role of the nephrometry score in predicting postoperative outcomes, the receiver-operating characteristic curves demonstrated that both the 2D and the 3D nephrometry score were correlated with overall and major complications (AUCs calculated with 3D VMs ranging from 0.67 to 0.84), confirming the findings in the literature [29,30]. Nephrometry category, as assessed by the two different imaging tools, was also considered in order to evaluate whether the 2D-or 3D-based category was more closely related to postoperative outcomes.…”

Section: Discussionsupporting

confidence: 83%

Three‐dimensional virtual imaging of renal tumours: a new tool to improve the accuracy of nephrometry scores

et al. 2019

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ObjectivesTo apply the standard PADUA and RENAL nephrometry score variables to three-dimensional (3D) virtual models (VMs) produced from standard bi-dimensional imaging, thereby creating three-dimensional (3D)-based (PADUA and RENAL) nephrometry scores/categories for the reclassification of the surgical complexity of renal masses, and to compare the new 3D nephrometry score/category with the standard 2D-based nephrometry score/category, in order to evaluate their predictive role for postoperative complications. Materials and MethodsAll patients with localized renal tumours scheduled for minimally invasive partial nephrectomy (PN) between September 2016 and September 2018 underwent 3D and 2D nephrometry score/category assessments preoperatively. After nephrometry score/category evaluation, all the patients underwent surgery. Chi-squared tests were used to evaluate the individual patients' grouping on the basis of the imaging tool (3D VMs and 2D imaging) used to assess the nephrometry score/category, while Cohen's j coefficient was used to test the concordance between classifications. Receiver-operating characteristic curves were produced to evaluate the sensitivity and specificity of the 3D nephrometry score/category vs the 2D nephrometry score/ category in predicting the occurrence of postoperative complications. A general linear model was used to perform multivariable analyses to identify predictors of overall and major postoperative complications. ConclusionsIn the present study, we showed that 3D VMs were more precise than 2D standard imaging in evaluating the surgical complexity of renal masses according to nephrometry score/ category. This was attributable to a better perception of tumour depth and its relationships with intrarenal structures using the 3D VM, as confirmed by the higher accuracy of the 3D VM in predicting postoperative complications.Additional Supporting Information may be found in the online version of this article: Table S1. Multivariable analysis identifying the preoperative independent predictors of overall complication and major complications for PADUA and RENAL score. 954

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“…PN is a complex surgical intervention and the prediction of surgical complication rate, in addition to the oncological and functional outcomes, is paramount to assess the risk/benefit ratio of PN compared to RN [13,14]. In our present study, the overall postoperative surgical complication rate was 10.2% and the major surgical postoperative complication rate was 2.5%.…”

Section: Discussionmentioning

confidence: 54%

Nomogram for predicting the likelihood of postoperative surgical complications in patients treated with partial nephrectomy: a prospective multicentre observational study (the RECORd 2 project)

et al. 2019

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nomogram for predicting the risk of postoperative surgical complications. At decision curve analysis, the nomogram led to superior outcomes for any decision associated with a threshold probability of >5%. ConclusionSeveral clinical predictors have been associated with postoperative surgical complications after PN. We used this information to develop and internally validate a nomogram to predict such risk.

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Impact of Host Factors on Robotic Partial Nephrectomy Outcomes: Comprehensive Systematic Review and Meta-Analysis

Cited by 43 publications

References 47 publications

The Simplified PADUA REnal (SPARE) nephrometry system: a novel classification of parenchymal renal tumours suitable for partial nephrectomy

The Simplified PADUA REnal (SPARE) nephrometry system: a novel classification of parenchymal renal tumours suitable for partial nephrectomy

Three‐dimensional virtual imaging of renal tumours: a new tool to improve the accuracy of nephrometry scores

Nomogram for predicting the likelihood of postoperative surgical complications in patients treated with partial nephrectomy: a prospective multicentre observational study (the RECORd 2 project)

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