Risk factors for intraoperative cyst rupture in partial nephrectomy for cystic renal masses.

To determine the risk factors of intraoperative cyst rupture in partial nephrectomy (PN) for a cystic renal mass (CRM) and their effect on the prognosis of patients.

Patients who underwent partial nephrectomy for CRMs from January 2009 to January 2015 were included. Uni/multivariate Logistic/Cox analysis and Kaplan-Meier analysis were performed.

A total of 174 patients were included in this study. There were 27 (15.5%) intraoperative cyst ruptures. The median follow-up time was 60 months. Multivariate logistic analysis showed that the E component (P = 0.018) and N component (P = 0.022) of the R.E.N.A.L. nephrometry score, Bosniak category III (P = 0.044), and surgeon's experience (P = 0.030) were risk factors associated with intraoperative cyst rupture in PN for CRMs. The 5-year recurrence-free survival (RFS), cancer-free survival (CFS) and overall survival (OS) were 92.7%, 90.32% and 94.4%, respectively, in 124 cases of malignant CRM. Kaplan-Meier analysis demonstrated that 5-year RFS and 5-year CFS in patients with cyst rupture was worse than those without cyst rupture (P = 0.006 and 0.003, respectively). Multivariate Cox analysis revealed that intraoperative cyst rupture was independent risk factor for 5-year RFS and 5-year CFS (P = 0.039 and 0.013, respectively). However, there was no significant difference in OS between the two groups (P = 0.275).

The prevalence of intraoperative cyst rupture is relatively high. Higher E and N scores, Bosniak category III, and lacking surgical experience (<20 cases) increase the risk of occurrence of intraoperative cyst rupture.

Asian journal of surgery. 2020 Apr 11 [Epub ahead of print]

Shao-Zhan Chen, Yu-Peng Wu, Shao-Hao Chen, Xiao-Dong Li, Xiong-Lin Sun, Jin-Bei Huang, Yong Wei, Qing-Shui Zheng, Xue-Yi Xue, Ning Xu

Departments of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China., Departments of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China. Electronic address: ., Departments of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China. Electronic address: .