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World Journal of Urology

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01-10-2012 | Original Article

Laparoscopic partial nephrectomy: risk stratification according to patient and tumor characteristics

Authors: Stephan Kruck, Aristoteles G. Anastasiadis, Ute Walcher, Arnulf Stenzl, Thomas R. W. Herrmann, Udo Nagele

Published in: World Journal of Urology | Issue 5/2012

Abstract

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.

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Title: Laparoscopic partial nephrectomy: risk stratification according to patient and tumor characteristics
Authors: Stephan Kruck
Aristoteles G. Anastasiadis
Ute Walcher
Arnulf Stenzl
Thomas R. W. Herrmann
Udo Nagele
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 5/2012
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-011-0806-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic partial nephrectomy: risk stratification according to patient and tumor characteristics

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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