MP42-05\u2003PERIOPERATIVE COMPLICATIONS AFTER PARTIAL NEPHRECTOMY FOR COMPLEX (PADUA SCORE ≥ 10) RENAL TUMORS: A PROSPECTIVE MULTICENTER OBSERVATIONAL STUDY (THE RECORD2 PROJECT)

Abstract

INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) is the standard treatment for localized renal tumors, although it can be challenging in case of anatomically complex renal masses. Aim of the present study is to report the perioperative complications and to search for their predictors in patients treated with PN for complex renal masses in a large multi-institutional prospective observational study. METHODS: We prospectively evaluated 4,308 patients treated with PN between January 2013 and December 2016 at 26 urological Italian Centers (RECORD2 project). Anthropometric data, comorbidities and perioperative outcomes were analyzed. Postoperative complications occurring within 30 days of surgery were registered and graded using the modified Clavien-Dindo scale. Complex renal masses were defined as any renal tumor with a PADUA score ≥ 10. An univariate and multivariable logistic regression analyses for surgical complication were performed. RESULTS: Overall, 410 patients treated with PN for complex masses were included. The American Society of Anesthesiologists physical status (ASA PS) score was 2 (IQR 2-3). Median pre-operative hemoglobin was 14.2 g/dL (IQR 13.0-15.0). Clinical T1b and T2 were 178 (43.4%) and 39 (9.5%) of the cases. PADUA score was 11, 12 and 13 in 143 (34.9%), 55 (13.4%) and 3 (0.7%) patients. Totally endophytic renal tumors were 125 (30.5%). Dislocation of the renal sinus and of the urinary collecting system was registered in 301 (73.4%) and 334 (81.5%) cases. 310 (75.6%) patients were treated in high volume centres. Overall, 188 (45.9%), 77 (18.8%) and 145 (35.4%) of patients underwent open, laparoscopic and robotic PN, respectively. Simple enucleation was performed in 29.3% of patients. Intraoperative complications occurred in 15 (3.7%) patients, including 2 cases of conversions from laparoscopic to open approach. Postoperative surgical complications were recorded in 60 (14.6%) of patients: 6.8% were Clavien 2 and 4.4% Clavien 3. No Clavien 4-5 complications were reported. Medical complications occurred in 14.6% of patients. At multivariable analysis, preoperative hemoglobin (OR 0.70, 95%CI 0.57-0.85 p<0.001) and open (OR 3.91, 95%CI 1.74-8.77 p<0.001) vs robotic surgical approach were found to be the only predictors of postoperative surgical complications after adjusting for ASA PS score, volume centre, PADUA score, resection technique. CONCLUSIONS: In a large contemporary series, PN is a safe and feasible technique in case of complex renal masses. Although the main goal of the intervention is to avoid the radical nephrectomy if technically and oncologically feasible, robotic PN should be considered even in case of complex nephrometry of the renal tumor. Source of Funding: None