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Analysis of Surgical Complications of Renal Tumor Enucleation with Standardized Instruments and External Validation of Padua Classification

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To assess surgical results and morbidity of tumor enucleation (TE), and to evaluate their correlation with PADUA nephrometric score.

Methods

We prospectively gathered data, including accurate analysis of tumor nephrometry, from 244 consecutive patients treated with TE for clinically localized renal cell carcinoma. All surgical results were collected, and perioperative complications were stratified for severity according to Clavien system. Correlation between preoperative variables and surgical results/complications was assessed with uni- and multivariate analysis.

Results

Mean (range) tumor size was 3.6 (0.8–10.0) cm, and mean (range) warm ischemia time was 16.8 (5–35) min. Overall, perioperative complications occurred in 45 patients (18.4 %), and of those 8 were medical and 37 were surgical (4 Clavien grade 1, 25 grade 2, and 8 grade 3) complications. Urine leakage rate was 2.0 %. No grade 4/5 complications occurred in this series. At univariate analysis PADUA score, endophytic tumor growth, tumor diameter, involvement of UCS and renal sinus resulted associated with warm ischemia time (p < 0.0001 each) and surgical complications (p = 0.0007, p = 0.049, p = 0.021, p = 0.036, and p = 0.029, respectively). At logistic regression, nephrometry score resulted independently associated with overall complications (related risk for each increased point 1.54; p = 0.017), surgical complications (related risk 1.58; p = 0.016), and Clavien grade 3 surgical complications (related risk 2.99; p = 0.008).

Conclusions

The TE technique was associated with a 15.2 % surgical complication rate with a 3.3 % reintervention rate (including ureteral stenting and superselective renal artery embolization). Tumor nephrometry and surgical indication resulted independent predictors of Clavien grade 3 complications. The PADUA score is a reliable tool to predict surgical results and morbidity of TE.

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Conflict of interest

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Authors and Affiliations

  1. Department of Urology, University of Florence, Careggi Hospital, Florence, Italy

    Andrea Minervini MD, PhD, Gianni Vittori MD, Matteo Salvi MD, Arcangelo Sebastianelli MD, Agostino Tuccio MD, Giampaolo Siena MD, Lorenzo Masieri MD, PhD, Mauro Gacci MD, Alberto Lapini MD, Sergio Serni & Marco Carini

Authors
  1. Andrea Minervini MD, PhD
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  2. Gianni Vittori MD
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  3. Matteo Salvi MD
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  4. Arcangelo Sebastianelli MD
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  5. Agostino Tuccio MD
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  6. Giampaolo Siena MD
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  7. Lorenzo Masieri MD, PhD
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  8. Mauro Gacci MD
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  9. Alberto Lapini MD
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  10. Sergio Serni
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  11. Marco Carini
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Corresponding author

Correspondence to Andrea Minervini MD, PhD.

Additional information

Andrea Minervini and Gianni Vittori contributed equally to this study and share primary authorship.

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Minervini, A., Vittori, G., Salvi, M. et al. Analysis of Surgical Complications of Renal Tumor Enucleation with Standardized Instruments and External Validation of Padua Classification. Ann Surg Oncol 20, 1729–1736 (2013). https://doi.org/10.1245/s10434-012-2801-9

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  • DOI: https://doi.org/10.1245/s10434-012-2801-9

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