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- Title
Outcomes of high-complexity renal tumours with a Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score of ≥10 after robot-assisted partial nephrectomy with a median 46.5-month follow-up: a tertiary centre experience.
- Authors
Abdel Raheem, Ali; Alatawi, Atalla; Kim, Dae K.; Sheikh, Abulhasan; Alabdulaali, Ibrahim; Han, Woong K.; Choi, Young D.; Rha, Koon H.
- Abstract
Objectives To compare perioperative trifecta achievement and long-term oncological and functional outcomes between patients with renal tumours of low [Preoperative Aspects and Dimensions Used for an Anatomical ( PADUA) score 6-7], intermediate ( PADUA score 8-9) and high ( PADUA score ≥10) complexity undergoing robot-assisted partial nephrectomy ( RAPN), and to determine predictors for trifecta achievement. Patients and Methods Data were retrospectively analysed from 295 patients, who underwent RAPN, between 2006 and 2015, at a high-volume tertiary centre. Trifecta achievement was the primary outcome measurement. The perioperative parameters and long-term oncological and functional outcomes were the secondary outcome measures. Groups were compared using the Kruskal-Wallis H test or chi-square test. Univariable and multivariable binary logistic regression analyses were used to determine the most important determinant variables associated with trifecta accomplishment. The Kaplan-Meier method was used to estimate overall survival ( OS), cancer-specific survival ( CSS) and cancer-free survival ( CFS). Results Of the 295 patients, 121 (41%) had a PADUA score of ≥10. Patients in the high-complexity PADUA group had larger tumours ( P ≤ 0.001), higher clinical stages ≥T1b ( P < 0.001), an increased risk of malignancy ( P = 0.02), longer warm ischaemia time ( P = 0.0030), and higher estimated blood loss ( P = 0.001) compared with those in the intermediate- and low-complexity groups. Seven of eight patients who were converted to radical nephrectomy had high-complexity tumours ( P = 0.02). Trifecta achievement was less in the high-complexity PADUA group ( P < 0.001). Renal functional outcomes did not differ among the groups at follow-up ( P > 0.05). There were no significant differences between the groups for OS ( P = 0.314), CSS ( P = 0.228) and CFS ( P = 0.532). In multivariable analysis, the American Society of Anesthesiologists classification, operative time and tumour size were independent predictors of trifecta achievement ( P = 0.001, P = 0.03, and P = 0.006, respectively). Conclusion High-complexity PADUA tumours are associated with a lower rate of trifecta achievement; however, long-term oncological and functional outcomes seem to be equivalent among high-, intermediate-, and low-complexity tumours. Despite the perioperative outcomes; high-complexity tumours can be handled successfully via the robotic approach and the improved long-term oncological and functional outcomes might be considered useful for patients counselling.
- Subjects
NEPHRECTOMY; MEDICAL robotics; KIDNEY tumors; LOGISTIC regression analysis; ISCHEMIA
- Publication
BJU International, 2016, Vol 118, Issue 5, p770
- ISSN
1464-4096
- Publication type
Article
- DOI
10.1111/bju.13501