To compare peri-operative trifecta achievement and long-term oncological and functional outcomes between low (6-7), intermediate (8-9) and high (≥10) PADUA complex renal tumors and to determine predictors for trifecta achievement.
A retrospective analysis of data from 295 patients, who underwent RPN between 2006 to 2015 at high-volume tertiary center was performed. Trifecta achievement was the main primary outcome measurement. The perioperative parameters and long-term oncological and functional outcomes were the secondary outcome measurements. Groups were compared using Kruskal-Wallis H test or chi-square. Univariable and multivariable binary logistic regression analyses were performed to determine the most important determinant variables associated with trifecta accomplishment. The Kaplan-Meier method was used to estimate for overall survival (OS), cancer-specific survival (CSS) and cancer-free survival (CFS).
Out of 295 patients, 121 (41%) had PADUA score ≥10. Patients in high complex PADUA group had a larger tumor size, higher clinical stage ≥T1b, an increased risk of malignancy, longer warm ischemia time (WIT) and increased estimated blood loss (EBL) compared to intermediate and low complex groups (p=<0.001,<0.001,0.02,0.003 and 0.001, respectively). Seven out of 8 patients, who were converted to radical nephrectomy (RN), had high complex tumors (p=0.02). Trifecta was less achieved in the high complex PADUA group (P<0.001). Renal function outcomes didn't differ among all groups on follow-up (P>0.05). No significant differences between the groups were found regarding the OS (P=0.314), CSS (P=0.228) and CFS (P=0.532). In multivariable analysis, the American Society of Anesthesiologists (ASA) classification, operative time and tumor size could independently predict trifecta achievement (p=0.001, 0.03, and 0.006, respectively).
High complex PADUA tumors are associated with a lower rate of trifecta achievement, however, long-term oncological and functional outcomes seem to be equivalent among high, intermediate, and low complex tumors. Despite of the perioperative outcomes; high complex tumors can be handled successfully via the robotic approach and the improved long-term oncological and functional outcomes might be considered useful for patients counseling. This article is protected by copyright. All rights reserved.
BJU international. 2016 Apr 22 [Epub ahead of print]
Ali Abdel Raheem, Atalla Alatawi, Dae Keun Kim, Abulhasan Sheikh, Ibrahim Alabdulaali, Woong Kyu Han, Young Deuk Choi, Koon Ho Rha
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea., Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea., Department of Urology, CHA Seoul Station Medical Center, CHA University Medical School, Seoul, Republic of Korea., Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea., Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea., Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea., Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea., Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.