The occurrence of intraoperative complications during partial nephrectomy and their impact on postoperative outcome: results from the RECORd1 project

Minervini, Andrea; Borghesi, Marco; Antonelli, Alessandro; Bertolo, Riccardo; Bianchi, Giampaolo; Brunocilla, Eugenio; Ficarra, Vincenzo; Fiori, Cristian; Longo, Nicola; Mirone, Vincenzo; Morgia, Giuseppe; Porpiglia, Francesco; Rocco, Bernardo; Serni, Sergio; Simeone, Claudio; Tellini, Riccardo; Volpe, Alessandro; Carini, Marco; Schiavina, Riccardo

doi:10.23736/s0393-2249.18.03202-2

Cited by 27 publications

(22 citation statements)

References 29 publications

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“…indeed, tumor excision might provoke pelvicalyceal system effraction, and vascular injury, especially during challenging procedures. 18 our data showed that the only 4 major complications in the rPN group were 3 urine leakage that required ureteral stent placement, and 1 abdominal bleeding which was managed with endovascular embolization. In addition, we found that ASA Score≥3, but no surgical technique, was the only factor associated with the risk of overall complications.…”

Section: Discussionmentioning

confidence: 63%

Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses

Veccia

Dell’Oglio

Antonelli

et al. 2020

Minerva Urol Nefrol

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BACKGROUND: Recent evidence suggests that the "oldest old" patients might benefit of partial nephrectomy (PN), but decision-making for this subset of patients is still controversial. aim of this study is to compare outcomes of robotic partial (rPN) or radical nephrectomy (rrN) for large renal masses in patients older than 65 years. METHODS: We identified 417≥65 years old patients who underwent RRN or RPN for cT1b or ≥cT2 renal mass at 17 high volume centers. Propensity score match analysis was performed adjusting for age, ASA≥3, pre-operative eGFR, and clinical tumor size. Predictors of complications, functional and oncological outcomes were evaluated in multivariable logistic and cox regression models. reSUlTS: after propensity score analysis, 73 patients in the rPN group were matched with 74 in the rrN group. r.e.N.a.l. Score (9.6±1.7 vs. 8.6±1.7; P<0.001), and high complexity (56 vs. 15%; P=0.001) were higher in the rrN. estimated blood loss was higher in the rPN group (200 vs. 100 ml; P<0.001). rPN showed higher rate of overall complications (38 vs. 23%; P=0.05), but not major complications (P=0.678). at last follow-up, rPN group showed better

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Section: Discussionmentioning

confidence: 63%

Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses

Veccia

Dell’Oglio

Antonelli

et al. 2020

Minerva Urol Nefrol

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“…Intraoperative complications are important considerations during surgery, since they are associated with adverse outcomes, such as greater blood loss, longer operative time, and even conversion to radical nephrectomy [ 11 14 18 ]. Few previous studies have focused on the importance of intraoperative complications, which may be partly due to their rarity.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative complications are rare during surgery in experienced hands, with a reported incidence rate of 5.0% to 13.5% [ 8 11 12 13 14 ]. Typically, conversion to radical surgery and local regional injury are commonly seen.…”

Section: Introductionmentioning

confidence: 99%

Development of a simple nomogram to estimate risk for intraoperative complications before partial nephrectomy based on the Mayo Adhesive Probability score combined with the RENAL nephrometry score

Tan

Jin

et al. 2021

Investig Clin Urol

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Purpose This study aimed to develop a simple nomogram based on the Mayo Adhesive Probability (MAP) score combined with the RENAL nephrometry score (RNS) to predict intraoperative complications before partial nephrectomy (PN) in Asian populations. Materials and Methods This study retrospectively collected patients undergoing PN at three medical centers. Each component of the MAP score and the RNS (6 variables) was evaluated to assess its association with intraoperative complications by multivariable logistic regression with backward elimination. Results A total of 46 cases (7.2%) with intraoperative complications were identified among 637 patients. After backward elimination, three variables, including tumor diameter (4–7 cm vs. ≤4 cm: odds ratio [OR], 4.339; 95% confidence interval [CI], 1.943–9,692; ≥7 cm vs. ≤4 cm: OR, 8.434; 95% CI, 1.225–58.090), nearness to the collecting system (4–7 mm vs. ≥7 mm: OR, 2.988; 95% CI, 1.293–6.907; ≤4 mm vs. ≥7 mm: OR, 21.394; 95% CI, 6.122–74.756), and perirenal fat stranding type (type 1 vs. no stranding: OR, 3.119; 95% CI, 1.079–9.017; type 2 vs. no stranding: OR, 18.722; 95% CI, 6.757–51.868), were retained. The predictive power (measured by area under the curve [AUC]) of the nomogram was observed to be superior to the RNS or MAP score alone (RNS: 0.686, MAP score: 0.729, the nomogram: 0.837), but comparable to their combination (0.813). Conclusions The simple nomogram contains fewer components than the combination of the RNS and MAP scores yet demonstrates equivalent predictive power for intraoperative complications.

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“…This may be associated with serious complications in patients with more comorbidities and poor physical tolerance. A prior study showed that about 5% of patients undergoing PN for a clinically localized renal tumor developed an intraoperative complication, 8 and higher American Anesthesiologists Score, complex RCC (eg, endophytic RCC), and the surgical technique were independent predictors of trifecta outcomes 9 . To reduce complications caused by PN and improve the quality of life for RCC patients, LA has gradually gained acceptance as an alternative to PN for patients with localized small RCC 2 .…”

Section: Discussionmentioning

confidence: 99%

“…However, given the complications 8,9 induced by surgical intervention and potential overtreatment for localized small kidney masses, 10 more effort should be made to minimize the risk of intraoperative complications during PN, and alternative approaches are necessary for high-risk patients. Local ablation (LA), mainly radiofrequency ablation and cryoablation, 2 has gradually gained acceptance as an option for localized small RCC.…”

Section: Introductionmentioning

confidence: 99%

Local ablation vs partial nephrectomy in T1N0M0 renal cell carcinoma: An inverse probability of treatment weighting analysis

Shi

Liu

et al. 2020

Cancer Medicine

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Objective To compare the survival outcomes of local ablation (LA) and partial nephrectomy (PN) for T1N0M0 renal cell carcinoma (RCC). Method We identified 38,155 T1N0M0 RCC patients treated with PN or LA in 2004‐2016 from the retrospective Surveillance, Epidemiology, and End Results databases. Among them, there were 4656 LA and 33,499 PN. A Cox proportional hazards regression model, cause‐specific Cox regression and Fine and Gray sub‐distribution hazard ratio (sHR) with inverse probability of treatment weighting (IPTW) adjusting was utilized to compare the effects of LA vs PN on all‐, RCC‐, and non‐RCC–caused mortality. Results Within the IPTW analysis, patients who underwent PN experienced a better overall survival (OS) (HR, 1.56; 95% CI, 1.40‐1.74; P < .001) and cancer‐specific survival (CSS) (HR, 2.21; 95% CI, 1.62‐2.98; P < .001) than LA patients. In the subgroup of patients >85 years (HR, 1.14; 95% CI, 0.73‐1.79, P = .577), chromophobe RCC (HR, 1.68; 95% CI, 0.94‐3.00, P = .078), and tumor size <2 cm (HR, 1.21; 95% CI, 0.95‐1.53, P = .126), the OS showed no significant difference between LA and PN. No significant difference in CSS between LA and PN was observed in the subgroup of chromophobe RCC (HR, 0.34; 95% CI, 0.03‐3.97, P = .389), and tumor size <2 cm (HR, 1.83; 95% CI, 0.92‐3.64, P = .084). For patients >85 years (sHR, 0.89; 95% CI, 0.52‐1.27, P = .520) and tumor size <2 cm (sHR, 1.14; 95% CI, 0.94‐1.38, P = .200), the non‐RCC–specific mortality was not significantly different in PN and LA cohorts, however, for the chromophobe RCC, the LA showed a worse non‐RCC mortality than PN (HR, 1.72; 95% CI, 1.06‐2.79, P = .028). Conclusion PN showed a better prognosis than LA in T1N0M0 RCC treatment, but LA and PN showed a comparable OS in elderly patients (>85), small RCC (<2 cm) and chromophobe RCC.

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The occurrence of intraoperative complications during partial nephrectomy and their impact on postoperative outcome: results from the RECORd1 project

Cited by 27 publications

References 29 publications

Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses

Robotic partial nephrectomy versus radical nephrectomy in elderly patients with large renal masses

Development of a simple nomogram to estimate risk for intraoperative complications before partial nephrectomy based on the Mayo Adhesive Probability score combined with the RENAL nephrometry score

Local ablation vs partial nephrectomy in T1N0M0 renal cell carcinoma: An inverse probability of treatment weighting analysis

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