Skip to main content
SpringerLink
Log in

External validation of the preoperative anatomical classification for prediction of complications related to nephron-sparing surgery

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Ficarra et al. (Eur Urol 56:786–793, 2009) published a preoperative anatomical classification (PADUA) to assess the impact of anatomical parameters of renal tumors on complication rate of nephron-sparing surgery (NSS). The objective of this study is to provide a bi-center external validation of this classification using the technique of hilar arterial clamping during open and laparoscopic NSS and to correlate the PADUA score to the ischemia time.

Methods

240 consecutive tumors treated with open and laparoscopic NSS were reclassified according to the PADUA classification. Complications were graded according to the modified Clavien system (Dindo et al. in Ann Surg 240:205–213, 2004). Chi-square tests and multivariate logistic regression models addressed the predictive value of PADUA classification on overall complication rate and grade.

Results

Mean patient age was 62.2 ± 13.3 years. Eastern Cooperative Oncology Group performance was 0 in 76%, 1 in 22% and 2 in 2%. 61 (25%) were treated laparoscopically. The median PADUA score was 7.5 (range 6–13). Mean surgery and ischemia time was 189 ± 95 and 24 ± 22 min, respectively. Overall complication rate was 23% (n = 54). On univariate analysis, the PADUA score correlated with complication rate (p < 0.001) of open and laparoscopic NSS. On multivariate, only the PADUA score correlated with complication rate (p = 0.0056). Ischemic time correlated with the PADUA score and was significantly higher in PADUA score ≥ 10 (p = 0.034).

Conclusions

The PADUA score is a reliable tool to preoperatively predict the risk of complications. In addition, it might be beneficial for a more objective patient selection for laparoscopic surgery and teaching NSS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ficarra V, Novara G, Secco S et al (2009) Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 56:786–793

    Article  Google Scholar 

  2. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  3. Peycelon M, Hupertan V, Comperat E et al (2009) Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol 181:35–41

    Article  PubMed  Google Scholar 

  4. Antonelli A, Cozzoli A, Nicolai M et al (2008) Nephron-sparing surgery versus radical nephrectomy in the treatment of intracapsular renal cell carcinoma up to 7 cm. Eur Urol 53:803–809

    Article  PubMed  Google Scholar 

  5. Uzzo RG, Novick AC (2001) Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 166:6–18

    Article  CAS  PubMed  Google Scholar 

  6. Novick AC, Campbell SC, Belldegrun A et al (2009) Guideline for management of the clinical stage 1 renal mass. American Urological Association. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/renalmass09.pdf

  7. Touijer K, Jacqmin D, Kavoussi LR et al (2010) The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications. Eur Urol 57:214–222

    Article  PubMed  Google Scholar 

  8. Joniau S, Vander Eeckt K, Srirangam SJ, Van Poppel H (2009) Outcome of nephron-sparing surgery for T1b renal cell carcinoma. BJU Int 103:1344–1348

    Article  PubMed  Google Scholar 

  9. Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853

    Article  PubMed  Google Scholar 

  10. Marszalek M, Meixl H, Polajnar M, Rauchenwald M, Jeschke K, Madersbacher S (2009) Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol 55:1171–1178

    Article  PubMed  Google Scholar 

  11. Weizer AZ, Gilbert SM, Roberts WW, Hollenbeck BK, Wolf JS Jr (2008) Tailoring technique of laparoscopic partial nephrectomy to tumor characteristics. J Urol 180:1273–1278

    Article  PubMed  Google Scholar 

  12. Porpiglia F, Volpe A, Billia M, Renard J, Scarpa RM (2008) Assessment of risk factors for complications of laparoscopic partial nephrectomy. Eur Urol 53:590–596

    Article  PubMed  Google Scholar 

  13. Venkatesh R, Weld K, Ames CD et al (2006) Laparoscopic partial nephrectomy for renal masses: effect of tumor location. Urology 67:1169–1174

    Article  PubMed  Google Scholar 

  14. Porpiglia F, Volpe A, Billia M, Scarpa RM (2008) Laparoscopic versus open partial nephrectomy: analysis of the current literature. Eur Urol 53:732–742

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Urology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Matthias Waldert, Tobias Klatte, Peter Weibl & Mesut Remzi

  2. Department of Urology, Medical School of Hannover, Hannover, Germany

    Sandra Waalkes, Markus A. Kuczyk & Axel S. Merseburger

  3. Department of Radiology, Medical University of Vienna, Vienna, Austria

    Gerd Schüller

Authors
  1. Matthias Waldert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandra Waalkes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tobias Klatte
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Markus A. Kuczyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter Weibl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gerd Schüller
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Axel S. Merseburger
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mesut Remzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthias Waldert.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Waldert, M., Waalkes, S., Klatte, T. et al. External validation of the preoperative anatomical classification for prediction of complications related to nephron-sparing surgery. World J Urol 28, 531–535 (2010). https://doi.org/10.1007/s00345-010-0577-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-010-0577-8

Keywords

Search

Navigation