MP37-12\u2003CLINICAL AND SURGICAL PREDICTORS OF MEDICAL AND SURGICAL POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH LIMITED LIFE EXPECTANCY TREATED WITH PARTIAL NEPHRECTOMY FOR RENAL TUMORS: INSIGHT FROM THE RECORD 2 PROJECT

Abstract

INTRODUCTION AND OBJECTIVES: To assess the predictors of postoperative medical and surgical complications in patients with limited life expectancy treated with partial nephrectomy (PN) for renal tumors in a large multicenter prospective observational study. METHODS: We prospectively gathered clinical data of 2,584 patients treated with PN at 26 urological Italian Centers from January 2013 to December 2016 (RECORd 2 project). Limited life expectancy was defined as an estimated 10-year survival (assessed using the age-adjusted Charlson comorbidity index (CCI)) <50%. Medical and surgical postoperative complications occurring within 30 days of surgery were assessed and graded using the modified Clavien-Dindo scale. RESULTS: Overall, the median estimated 10-year survival was 72.1% (IQR 26.4%-90.1%): 874 (33.8%) patients had a limited life expectancy. Of these, the median age-adjusted CCI and American Society of Anesthesiologists (ASA) physical status (PS) score were 6 (5-7) and 2 (2-3). Patients had a median baseline estimated glomerular filtration rate (eGFR) of 74.9 (62.3-88.4). The cT1b and cT2 renal tumors were reported in 21.4% and 3.0% of cases. The median PADUA score was 7 (IQR 7-9). Patients were treated with open, laparoscopic and robotic PN in 326 (37.3%), 226 (25.9%) and 322 (36.8%). Patients were treated in high-volume centres (>50 PN/year) in 584 (66.8%) of cases. Medical complications were reported in 65 (7.4%) cases: 22 (2.5%) were Clavien 1, 26 (3%) Clavien 2, 2 (0.2%) Clavien 3a, 2 (0.2%) Clavien 5. Surgical complications were reported in 148 (16.9%) cases: 32 (3.7%) were Clavien 1, 86 (9.8%) Clavien 2, 10 (1.1%) Clavien 3a, 15 (1.7%) Clavien 3b, 4 (0.5%) Clavien 4. At multivariable analyses, ASA PS score (OR 2.21, 95%CI 1.2-3.89, p=0.006), history of cerebrovascular disease (OR 3.32, 95%CI 1.49-7.41, p=0.03), high versus low-volume centre (OR 2.21, 95%CI 1.17-4.17, p=0.01) were independent predictors of medical postoperative complications after adjusting for history of cardiovascular disease, PADUA score, surgical approach, hilar clamping. The clinical tumor stage (cT1b vs cT1a (OR 1.55, 95%CI 0.97-2.49, p=0.06) and cT2 vs cT1a (OR 3.63, 95%CI 1.44-9.12, p=0.06), overall p=0.01), open (OR 2.00, 95%CI 1.23-3.28, p=0.006) versus robotic approach, the ASA PS score (OR 1.74, 95%CI 1.22-2.49, p=0.002) and the baseline eGFR (OR 0.99, 95%CI 0.98-0.99, p=0.03) were independent predictors of medical postoperative complications after adjusting for PADUA score and volume centre. CONCLUSIONS: PN is a safe surgical procedure even in patients with limited life expectancy. We identified clinical and surgical predictors of complications after PN to allow a more accurate individual risk stratification in patients with a limited life expectancy. Source of Funding: None