Previous robot-assisted partial nephrectomy (RAPN) studies have identified various predictors of overall and major postoperative complications, but few have evaluated the specific role of these factors in the development of medical and surgical complications. In this study we present an analysis of the modifiable and non-modifiable variables influencing medical and surgical complications in a contemporary series of patients who underwent RAPN and were followed in a prospectively maintained, multi-institutional kidney cancer database.
A retrospective review of all patients who underwent RAPN at four institutions between 2008 and 2015 was performed. Multivariable logistic regression models were used to determine predictors of medical and surgical postoperative complications.
Data from 1,139 patients were available for analysis. Sixty-seven patients (5.8%) experienced a medical postoperative complication, and 82 (7.1%) experienced a surgical complication. Decreasing baseline eGFR (OR=0.98, p=.003), greater estimated blood loss (OR=1.002, p=.001) and operating surgeon (OR=8.01, p<.001) were associated with an increased likelihood of surgical complications while decreasing baseline eGFR (OR=0.99, p=.054) and operating surgeon (OR=1.96, p=.054) were associated with an increased likelihood of medical complications.
We present complication risks in a large contemporary cohort of patients undergoing RPN with only 11.3% of patients experiencing a medical or surgical post-operative complication. Prospective candidates for robotic partial nephrectomy with poor baseline renal function and or risk factors for greater EBL including a high body mass index, or a complex renal mass should be counseled appropriately on their increased risk for a medical or surgical post-operative complication.
Journal of endourology. 2016 Oct 26 [Epub ahead of print]
Eric J Moskowitz, David Joseph Paulucci, Balaji N Reddy, Kyle Blum, Daniel C Rosen, Ronney Abaza, Daniel Eun, Ashok Hemal, L Spencer Krane, Ketan K Badani
Icahn School of Medicine at Mount Sinai, 5925, Urology , 5 E 98th Street , 6th Floor , New York, New York, United States , 10029-6574 ; ., Icahn School of Medicine at Mount Sinai Hospital, Urology , 5 E98th Street, 6th Floor , New York, New York, United States , 10029 ; ., Icahn School of Medicine at Mount Sinai, Urology , 1425 Madison Av , Icahn Medical Institute, , 6th Floor, Room L6-70 , New York, New York, United States , 10029 ; ., Icahn School of Medicine at Mount Sinai, 5925, Urology , 1425 Madison Ave , 6th Floor , New York, New York, United States , 10029-6574 ; ., Harvard Medical School, Boston, United States ; ., OhioHealth Dublin Methodist Hospital, Columbus, United States ; ., Temple University, Urology , 255 South 17th street , 7th Floor Urology Suite , Philadelphia, Pennsylvania, United States , 19103 ; ., Wake Foresty University Baptist Medical Center, Urology , Medical Center Blvd , Winston-Salem, North Carolina, United States , 27157 ; ., Wake Forest University, Urology, Winston Salem, North Carolina, United States ; ., Icahn School of Medicine at Mount Sinai Hospital, Urology, New York, New York, United States ; .