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Laparoscopic partial nephrectomy: risk stratification according to patient and tumor characteristics

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Abstract

Purpose

Laparoscopic partial nephrectomy (LPN) is the treatment of choice for localized tumors in many centers. We aimed to evaluate differences in complication rates and outcome stratified by risk categories, depending on patient or tumor characteristics.

Methods

Eighty-one patients who underwent LPN for localized renal tumors between 2004 and 2007 were evaluated. Clinical and pathological data, including localization, size and infiltration depth (classified according to PADUA and RENAL score), at initial radiologic imaging were analyzed. Results were correlated with complications during or after surgery, operative time, warm ischemia time and clinical outcome.

Results

Overall complication rate was 13.6% for LPN (11 patients, Clavien-Dindo classification: II–III). No significant correlations were found for patient-based risk classification models (age > 70 years, ASA-status >2, BMI > 30). A higher mean operative time was observed in centrally located tumors (P = 0.045). Increased hemoglobin loss was observed in central (P = 0.007), PADUA > 8 (P = 0.006) and RENAL > 7 (P = 0.002) tumors. Impaired renal function (creatinine increase in postoperative controls) was associated with tumor diameter > 4 cm (P = 0.023). Only central tumor growth had a significant predictive value for postoperative complications (P = 0.007). In patients with central tumor growth (P = 0.002), PADUA > 8 (P = 0.041) and RENAL > 7 (P = 0.044) scores, hospital stay was prolonged.

Conclusions

Uni and multifactorial scoring systems have been developed for LPN to identify potentially high-risk patients. In our series, only central tumor growth pattern enabled the prediction of increased operation time, hemoglobin loss, hospitalization as well as postoperative complications.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, University of Tuebingen, Tuebingen, Germany

    Stephan Kruck & Arnulf Stenzl

  2. Department of Urology, Eilenriede Clinic, Hannover, Germany

    Aristoteles G. Anastasiadis

  3. Department of Urology, General Hospital Hall i.T, Milser Straße 10–12, 6060, Hall in Tirol, Austria

    Ute Walcher & Udo Nagele

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

    Thomas R. W. Herrmann

Authors
  1. Stephan Kruck
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  2. Aristoteles G. Anastasiadis
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  3. Ute Walcher
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  4. Arnulf Stenzl
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  5. Thomas R. W. Herrmann
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  6. Udo Nagele
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Correspondence to Udo Nagele.

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Kruck, S., Anastasiadis, A.G., Walcher, U. et al. Laparoscopic partial nephrectomy: risk stratification according to patient and tumor characteristics. World J Urol 30, 639–646 (2012). https://doi.org/10.1007/s00345-011-0806-9

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  • DOI: https://doi.org/10.1007/s00345-011-0806-9

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