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Simhan J , Smaldone MC , Tsai KJ , Canter DJ , Li TY , Kutikov A , Viterbo R , Chen DYT , Greenberg RE , Uzzo RG
Objective Measures of Renal Mass Anatomic Complexity Predict Rates of Major Complications Following Partial Nephrectomy
European Urology. 2011 Oct;60(4) :724-730
PMID: WOS:000294304100023    PMCID: PMC3319121   
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Background: The association between tumor complexity and postoperative complications after partial nephrectomy (PN) has not been well characterized. Objective: We evaluated whether increasing renal tumor complexity, quantitated by nephrometry score (NS), is associated with increased complication rates following PN using the Clavien-Dindo classification system (CCS). Design, setting, and participants: We queried our prospectively maintained kidney cancer database for patients undergoing PN from 2007 to 2010 for whom NS was available. Interventions: All patients underwent PN. Measurements: Tumors were categorized into low-(NS: 4-6), moderate-(NS: 7-9), and high-complexity (NS: 10-12) lesions. Complication rates within 30 d were graded (CCS: I-5), stratified as minor (CCS: I or 2) or major (CCS: 3-5), and compared between groups. Results and limitations: A total of 390 patients (mean age: 58.0 +/- 11.9 yr; 66.9% male) undergoing PN (44.6% open, 55.4% robotic) for low-(28%), moderate-(55.6%), and high-complexity (16.4%) tumors (mean tumor size: 3.74 +/- 2.4 cm; median: 3.2 cm) from 2007 to 2010 were identified. Tumor size, estimated blood loss, and ischemia time all significantly differed (p < 0.0001) between groups; patient age, body mass index (BMI), and operative time were comparable. When stratified by CCS, minor and major complication rates for all patients were 26.7% and 11.5%, respectively. Minor complication rates were comparable (26.6 vs 24.9 vs 32.8%; p = 0.45), whereas major complication rates differed (6.4 vs 11.1 vs 21.9%; p = 0.009) among tumor complexity groups. Controlling for age, gender, BMI, type of surgical approach, operative duration, and tumor complexity, prolonged operative time (odds ratio [OR]: 1.01; confidence interval [CI], 1.0-1.02) and high tumor complexity (OR: 5.4; CI, 1.2-24.2) were associated with the postoperative development of a major complication. Lack of external validation is a limitation of this study. Conclusions: Increasing tumor complexity is associated with the development of major complications after PN. This association should be validated externally and integrated into the decision-making process when counseling patients with complex renal tumors. (C) 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Simhan, Jay Smaldone, Marc C. Tsai, Kevin J. Canter, Daniel J. Li, Tianyu Kutikov, Alexander Viterbo, Rosalia Chen, David Y. T. Greenberg, Richard E. Uzzo, Robert G. National Cancer Institute[P30 CA006927]; Department of Defense; Fox Chase Cancer This publication was supported in part by grant number P30 CA006927 from the National Cancer Institute and by the Department of Defense, Physician Research Training Award (AK). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute, the National Institutes of Health, or the Department of Defense. Additional funds were provided by Fox Chase Cancer via institutional support of the Kidney Cancer Keystone Program. 29 Elsevier science bv Amsterdam 812oz