PURPOSE: Laparoscopic partial nephrectomy (LPN) is the treatment of choice for localized tumors in many centers. We aimed to evaluate differences in complication rates and outcome stratified by risk categories, depending on patient or tumor characteristics. METHODS: Eighty-one patients who underwent LPN for localized renal tumors between 2004 and 2007 were evaluated. Clinical and pathological data, including localization, size and infiltration depth (classified according to PADUA and RENAL score), at initial radiologic imaging were analyzed. Results were correlated with complications during or after surgery, operative time, warm ischemia time and clinical outcome. RESULTS: Overall complication rate was 13.6% for LPN (11 patients, Clavien-Dindo classification: II-III). No significant correlations were found for patient-based risk classification models (age > 70 years, ASA-status >2, BMI > 30). A higher mean operative time was observed in centrally located tumors (P = 0.045). Increased hemoglobin loss was observed in central (P = 0.007), PADUA > 8 (P = 0.006) and RENAL > 7 (P = 0.002) tumors. Impaired renal function (creatinine increase in postoperative controls) was associated with tumor diameter > 4 cm (P = 0.023). Only central tumor growth had a significant predictive value for postoperative complications (P = 0.007). In patients with central tumor growth (P = 0.002), PADUA > 8 (P = 0.041) and RENAL > 7 (P = 0.044) scores, hospital stay was prolonged. CONCLUSIONS: Uni and multifactorial scoring systems have been developed for LPN to identify potentially high-risk patients. In our series, only central tumor growth pattern enabled the prediction of increased operation time, hemoglobin loss, hospitalization as well as postoperative complications.
PURPOSE: Laparoscopic partial nephrectomy (LPN) is the treatment of choice for localized tumors in many centers. We aimed to evaluate differences in complication rates and outcome stratified by risk categories, depending on patient or tumor characteristics. METHODS: Eighty-one patients who underwent LPN for localized renal tumors between 2004 and 2007 were evaluated. Clinical and pathological data, including localization, size and infiltration depth (classified according to PADUA and RENAL score), at initial radiologic imaging were analyzed. Results were correlated with complications during or after surgery, operative time, warm ischemia time and clinical outcome. RESULTS: Overall complication rate was 13.6% for LPN (11 patients, Clavien-Dindo classification: II-III). No significant correlations were found for patient-based risk classification models (age > 70 years, ASA-status >2, BMI > 30). A higher mean operative time was observed in centrally located tumors (P = 0.045). Increased hemoglobin loss was observed in central (P = 0.007), PADUA > 8 (P = 0.006) and RENAL > 7 (P = 0.002) tumors. Impaired renal function (creatinine increase in postoperative controls) was associated with tumor diameter > 4 cm (P = 0.023). Only central tumor growth had a significant predictive value for postoperative complications (P = 0.007). In patients with central tumor growth (P = 0.002), PADUA > 8 (P = 0.041) and RENAL > 7 (P = 0.044) scores, hospital stay was prolonged. CONCLUSIONS: Uni and multifactorial scoring systems have been developed for LPN to identify potentially high-risk patients. In our series, only central tumor growth pattern enabled the prediction of increased operation time, hemoglobin loss, hospitalization as well as postoperative complications.
Authors: Lee Richstone; Sylvia Montag; Michael C Ost; Ernesto Reggio; Casey Seideman; Sompol Permpongkosol; Ardeshir R Rastinehad; Louis R Kavoussi Journal: Urology Date: 2011-01 Impact factor: 2.649
Authors: Anup P Ramani; Mihir M Desai; Andrew P Steinberg; Christopher S Ng; Sidney C Abreu; Jihad H Kaouk; Antonio Finelli; Andrew C Novick; Inderbir S Gill Journal: J Urol Date: 2005-01 Impact factor: 7.450
Authors: R Houston Thompson; Brian R Lane; Christine M Lohse; Bradley C Leibovich; Amr Fergany; Igor Frank; Inderbir S Gill; Michael L Blute; Steven C Campbell Journal: Eur Urol Date: 2010-06-09 Impact factor: 20.096
Authors: Alberto Breda; Antonio Finelli; Gunter Janetschek; Francesco Porpiglia; Francesco Montorsi Journal: Eur Urol Date: 2009-01-20 Impact factor: 20.096
Authors: Tobias Klatte; Vincenzo Ficarra; Christian Gratzke; Jihad Kaouk; Alexander Kutikov; Veronica Macchi; Alexandre Mottrie; Francesco Porpiglia; James Porter; Craig G Rogers; Paul Russo; R Houston Thompson; Robert G Uzzo; Christopher G Wood; Inderbir S Gill Journal: Eur Urol Date: 2015-04-22 Impact factor: 20.096