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American Confederation of Urology (CAU) experience in minimally invasive partial nephrectomy
- Source :
- WORLD JOURNAL OF UROLOGY, r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau, instname
- Publication Year :
- 2016
- Publisher :
- Springer Science and Business Media LLC, 2016.
-
Abstract
- To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014. Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95 % confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used. We evaluated 1501 laparoscopic (98 %) or robotic (2 %) PNs. Median age: 58 years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20 min and 200 cc. 81 % of the lesions were malignant, with clear cell histology being 65 % of the total. Median maximum tumor diameter is 2.7 cm, positive margin is 8.2 %, and median hospitalization is 3 days. One or more postoperative complication was recorded in 19.8 % of the patients: Clavien 1: 5.6 %; Clavien 2: 8.4 %; Clavien 3A: 1.5 %; Clavien 3B: 3.2 %; Clavien 4A: 1 %; Clavien 4B: 0.1 %; Clavien 5: 0 %. Bleeding was the main cause of a reoperation (5.5 %), conversion to radical nephrectomy (3 %) or open partial nephrectomy (6 %). Transfusion rate is 10 %. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95 % CI 1.02-1.2; p = 0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37 years. The 5-year progression or kidney cancer mortality-free rate was 94 % (95 % CI 90, 97). Positive margins (HR 4.98; 95 % CI 1.3-19; p = 0.02) and females (HR 5.6; 95 % CI 1.7-19; p = 0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter. Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.
- Subjects :
- Male
Nephrology
Databases, Factual
medicine.medical_treatment
Blood Loss, Surgical
030232 urology & nephrology
Kaplan-Meier Estimate
Nephrectomy
Postoperative Complications
0302 clinical medicine
Robotic Surgical Procedures
Adenoma, Oxyphilic
Partial nephrectomy
Warm Ischemia
Laparoscopy
medicine.diagnostic_test
Margins of Excision
Kidney cancer
Middle Aged
Conversion to Open Surgery
Kidney Neoplasms
Tumor Burden
030220 oncology & carcinogenesis
Female
medicine.medical_specialty
Urology
Angiomyolipoma
Operative Time
03 medical and health sciences
Internal medicine
medicine
Hand-Assisted Laparoscopy
Humans
Minimally Invasive Surgical Procedures
Carcinoma, Renal Cell
Mexico
Aged
Neoplasm Staging
Proportional Hazards Models
business.industry
Proportional hazards model
Postoperative complication
Perioperative
Length of Stay
South America
medicine.disease
Confidence interval
Surgery
Nephron sparing
Logistic Models
Spain
Multivariate Analysis
business
Subjects
Details
- ISSN :
- 14338726 and 07244983
- Volume :
- 35
- Database :
- OpenAIRE
- Journal :
- World Journal of Urology
- Accession number :
- edsair.doi.dedup.....65c9ff7f5f2e1d44769c38f4df508f8b