WHICH PROCEDURES ASSOCIATED TO RADICAL NEPHRECTOMY COULD
AFFECT POST-OPERATIVE COMPLICATION RATE? EVALUATION IN 1300
PATIENTS’ COHORT
A. Antonelli, N. Arrighi, S. Corti, S. Legramanti, T. Zanotelli, A. Cozzoli, S. Cosciani Cunico,
C. Simeone (Brescia)
Aim of the study
– Nephrectomy (RN) remains an option in treatment of renal cell carcinoma, and by European
Guidelines, it is suggest in cT3 disease and when a NSS seems not possible in lower staging. On
the other side, nephrectomy is performed more than suggested to Guidelines, maybe also because
seems affected by lower complication rate [Val Poppel 2007, Eur Urol] especially in low outload centers. We try to evaluate role of different procedure associated to RN, relating them to
complication rate.
Materials and methods
Our Renal Carcinoma Database has been perpectivally stored between 1985 and 2012. It has
been carried on systemic storing of data about post-operative complications, and have been
classified by Clavien-Dindo System [Clavien,Ann Surg 2009]. In this database, are stored data
about RNs, carried on in accordance with current Guidelines, with prevalence of lumbotomic
access, anterior approach in advanced diseases or contemporary other abdominal surgical
procedures. We try to evaluate relation between complication (Clavien grade => 3) and these
surgical procedures: lymphoadenectomy, ipsylateral adrenalectomy, controlateral renal surgical
procedure, cavotomy to remove thrombus, other organ surgery; other parameters have bee
evaluate: age, gender, comorbidity (Charlson score > or < to 3), diameter, hystology (benign vs
malignant); staging, surgical access. We excluded laparoscopic nephrectomy.
Results
1327 patients (564 F, 823 M, average age 62.4 +/-14.6y) respect the inclusion criteria. In 337
(25.4 %) have been registered 405 adverse events (1.2 pro patient). Considering the worst
between events, 109 have had grade 1, 157 a level 2, 16 a 3a, 25 a 3b, 21 a 4, and 9 a 5. So, 71
patients developed a grade 3 level or more event (5.4 %) Table resume results.
Discussion
1327 patients (564 F, 823 M, average age 62.4 +/-14.6y) respect the inclusion criteria. In 337
(25.4 %) have been registered 405 adverse events (1.2 pro patient). Considering the worst
between events, 109 have had grade 1, 157 a level 2, 16 a 3a, 25 a 3b, 21 a 4, and 9 a 5. So, 71
patients developed a grade 3 level or more event (5.4 %) Table resume results.
Conclusions
none of procedures that normally could be associated to nephrectomy showed a correlation to
increase in post-operative complications (lynmphadenectomy, adrenalectomy, anterior
approach). On the other side, age and cavotomy (riserve to pT3b diseases) improve the postoperative risk to high grade complications.