Skip to main content
Top
Published in: World Journal of Urology 4/2010

01-08-2010 | Original Article

External validation of the preoperative anatomical classification for prediction of complications related to nephron-sparing surgery

Authors: Matthias Waldert, Sandra Waalkes, Tobias Klatte, Markus A. Kuczyk, Peter Weibl, Gerd Schüller, Axel S. Merseburger, Mesut Remzi

Published in: World Journal of Urology | Issue 4/2010

Login to get access

Abstract

Purpose

Ficarra et al. (Eur Urol 56:786–793, 2009) published a preoperative anatomical classification (PADUA) to assess the impact of anatomical parameters of renal tumors on complication rate of nephron-sparing surgery (NSS). The objective of this study is to provide a bi-center external validation of this classification using the technique of hilar arterial clamping during open and laparoscopic NSS and to correlate the PADUA score to the ischemia time.

Methods

240 consecutive tumors treated with open and laparoscopic NSS were reclassified according to the PADUA classification. Complications were graded according to the modified Clavien system (Dindo et al. in Ann Surg 240:205–213, 2004). Chi-square tests and multivariate logistic regression models addressed the predictive value of PADUA classification on overall complication rate and grade.

Results

Mean patient age was 62.2 ± 13.3 years. Eastern Cooperative Oncology Group performance was 0 in 76%, 1 in 22% and 2 in 2%. 61 (25%) were treated laparoscopically. The median PADUA score was 7.5 (range 6–13). Mean surgery and ischemia time was 189 ± 95 and 24 ± 22 min, respectively. Overall complication rate was 23% (n = 54). On univariate analysis, the PADUA score correlated with complication rate (p < 0.001) of open and laparoscopic NSS. On multivariate, only the PADUA score correlated with complication rate (p = 0.0056). Ischemic time correlated with the PADUA score and was significantly higher in PADUA score ≥ 10 (p = 0.034).

Conclusions

The PADUA score is a reliable tool to preoperatively predict the risk of complications. In addition, it might be beneficial for a more objective patient selection for laparoscopic surgery and teaching NSS.
Literature
1.
go back to reference Ficarra V, Novara G, Secco S et al (2009) Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 56:786–793CrossRef Ficarra V, Novara G, Secco S et al (2009) Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 56:786–793CrossRef
2.
go back to reference Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMed Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMed
3.
go back to reference Peycelon M, Hupertan V, Comperat E et al (2009) Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol 181:35–41CrossRefPubMed Peycelon M, Hupertan V, Comperat E et al (2009) Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol 181:35–41CrossRefPubMed
4.
go back to reference Antonelli A, Cozzoli A, Nicolai M et al (2008) Nephron-sparing surgery versus radical nephrectomy in the treatment of intracapsular renal cell carcinoma up to 7 cm. Eur Urol 53:803–809CrossRefPubMed Antonelli A, Cozzoli A, Nicolai M et al (2008) Nephron-sparing surgery versus radical nephrectomy in the treatment of intracapsular renal cell carcinoma up to 7 cm. Eur Urol 53:803–809CrossRefPubMed
5.
go back to reference Uzzo RG, Novick AC (2001) Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 166:6–18CrossRefPubMed Uzzo RG, Novick AC (2001) Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 166:6–18CrossRefPubMed
7.
go back to reference Touijer K, Jacqmin D, Kavoussi LR et al (2010) The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications. Eur Urol 57:214–222CrossRefPubMed Touijer K, Jacqmin D, Kavoussi LR et al (2010) The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications. Eur Urol 57:214–222CrossRefPubMed
8.
go back to reference Joniau S, Vander Eeckt K, Srirangam SJ, Van Poppel H (2009) Outcome of nephron-sparing surgery for T1b renal cell carcinoma. BJU Int 103:1344–1348CrossRefPubMed Joniau S, Vander Eeckt K, Srirangam SJ, Van Poppel H (2009) Outcome of nephron-sparing surgery for T1b renal cell carcinoma. BJU Int 103:1344–1348CrossRefPubMed
9.
go back to reference Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853CrossRefPubMed Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853CrossRefPubMed
10.
go back to reference Marszalek M, Meixl H, Polajnar M, Rauchenwald M, Jeschke K, Madersbacher S (2009) Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol 55:1171–1178CrossRefPubMed Marszalek M, Meixl H, Polajnar M, Rauchenwald M, Jeschke K, Madersbacher S (2009) Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol 55:1171–1178CrossRefPubMed
11.
go back to reference Weizer AZ, Gilbert SM, Roberts WW, Hollenbeck BK, Wolf JS Jr (2008) Tailoring technique of laparoscopic partial nephrectomy to tumor characteristics. J Urol 180:1273–1278CrossRefPubMed Weizer AZ, Gilbert SM, Roberts WW, Hollenbeck BK, Wolf JS Jr (2008) Tailoring technique of laparoscopic partial nephrectomy to tumor characteristics. J Urol 180:1273–1278CrossRefPubMed
12.
go back to reference Porpiglia F, Volpe A, Billia M, Renard J, Scarpa RM (2008) Assessment of risk factors for complications of laparoscopic partial nephrectomy. Eur Urol 53:590–596CrossRefPubMed Porpiglia F, Volpe A, Billia M, Renard J, Scarpa RM (2008) Assessment of risk factors for complications of laparoscopic partial nephrectomy. Eur Urol 53:590–596CrossRefPubMed
13.
go back to reference Venkatesh R, Weld K, Ames CD et al (2006) Laparoscopic partial nephrectomy for renal masses: effect of tumor location. Urology 67:1169–1174CrossRefPubMed Venkatesh R, Weld K, Ames CD et al (2006) Laparoscopic partial nephrectomy for renal masses: effect of tumor location. Urology 67:1169–1174CrossRefPubMed
14.
go back to reference Porpiglia F, Volpe A, Billia M, Scarpa RM (2008) Laparoscopic versus open partial nephrectomy: analysis of the current literature. Eur Urol 53:732–742CrossRefPubMed Porpiglia F, Volpe A, Billia M, Scarpa RM (2008) Laparoscopic versus open partial nephrectomy: analysis of the current literature. Eur Urol 53:732–742CrossRefPubMed
Metadata
Title
External validation of the preoperative anatomical classification for prediction of complications related to nephron-sparing surgery
Authors
Matthias Waldert
Sandra Waalkes
Tobias Klatte
Markus A. Kuczyk
Peter Weibl
Gerd Schüller
Axel S. Merseburger
Mesut Remzi
Publication date
01-08-2010
Publisher
Springer-Verlag
Published in
World Journal of Urology / Issue 4/2010
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-010-0577-8

Other articles of this Issue 4/2010

World Journal of Urology 4/2010 Go to the issue