Andrea Mari1, Riccardo Campi1, Riccardo Schiavina2,3, Daniele Amparore4, Alessandro Antonelli5, Walter Artibani6, Maurizio Barale7, Roberto Bertini8, Marco Borghesi2,3, Pierluigi Bove9, Eugenio Brunocilla2,3, Umberto Capitanio8, Luigi Da Pozzo10, Julian Daja5, Paolo Gontero7, Alessandro Larcher8, Vincenzo Li Marzi11, Nicola Longo12, Vincenzo Mirone12, Emanuele Montanari13, Francesca Pisano7, Francesco Porpiglia4, Claudio Simeone5, Salvatore Siracusano6, Riccardo Tellini1, Carlo Trombetta14, Alessandro Volpe15, Vincenzo Ficarra16, Marco Carini1, Andrea Minervini1. 1. Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. 2. Department of Urology, University of Bologna, Bologna, Italy. 3. Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy. 4. Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy. 5. Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy. 6. Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy. 7. Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy. 8. Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. 9. Department of Urology, University of Tor Vergata, San Carlo di Nancy Hospital, Rome, Italy. 10. Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy. 11. Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. 12. Department of Urology, University Federico II of Naples, Naples, Italy. 13. Department of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy. 14. U.C.O. Clinica Urologica, Università degli Studi di Trieste, Trieste, Italy. 15. Department of Urology, Maggiore della Carità Hospital, Novara, Italy. 16. Urologic Section, Department of Human and Paediatric Pathology, University of Messina, Messina, Italy.
Abstract
OBJECTIVE: To identify meaningful predictors and to develop a nomogram of postoperative surgical complications in patients treated with partial nephrectomy (PN). PATIENTS AND METHODS: We prospectively evaluated 4308 consecutive patients who had surgical treatment for renal tumours, between 2013 and 2016, at 26 Italian urological centres (RECORd 2 project). A multivariable logistic regression for surgical complications was performed. A nomogram was created from the multivariable model. Internal validation processes were performed using bootstrapping with 1000 repetitions. RESULTS: Overall, 2584 patients who underwent PN were evaluated for the final analyses. The median (interquartile [IQR]) American Society of Anesthesiologists (ASA) score was 2 (2-3). In all, 72.4% of patients had clinical T1a (cT1a) stage tumours. The median (IQR) Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 7 (6-8). Overall, 34.3%, 27.7%, 38% of patients underwent open PN (OPN), laparoscopic PN (LPN), and robot-assisted PN (RAPN). Overall and major postoperative surgical complications were recorded in 10.2% and 2.5% of patients, respectively. At multivariable analysis, age, ASA score, cT2 vs cT1a stage, PADUA score, preoperative anaemia, OPN and LPN vs RAPN, were significant predictive factors of postoperative surgical complications. We used these variables to construct a 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%. CONCLUSION: Several 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.
OBJECTIVE: To identify meaningful predictors and to develop a nomogram of postoperative surgical complications in patients treated with partial nephrectomy (PN). PATIENTS AND METHODS: We prospectively evaluated 4308 consecutive patients who had surgical treatment for renal tumours, between 2013 and 2016, at 26 Italian urological centres (RECORd 2 project). A multivariable logistic regression for surgical complications was performed. A nomogram was created from the multivariable model. Internal validation processes were performed using bootstrapping with 1000 repetitions. RESULTS: Overall, 2584 patients who underwent PN were evaluated for the final analyses. The median (interquartile [IQR]) American Society of Anesthesiologists (ASA) score was 2 (2-3). In all, 72.4% of patients had clinical T1a (cT1a) stage tumours. The median (IQR) Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 7 (6-8). Overall, 34.3%, 27.7%, 38% of patients underwent open PN (OPN), laparoscopic PN (LPN), and robot-assisted PN (RAPN). Overall and major postoperative surgical complications were recorded in 10.2% and 2.5% of patients, respectively. At multivariable analysis, age, ASA score, cT2 vs cT1a stage, PADUA score, preoperative anaemia, OPN and LPN vs RAPN, were significant predictive factors of postoperative surgical complications. We used these variables to construct a 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%. CONCLUSION: Several 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.