Back to 2011 Program

Abstract
Introduction: We evaluated whether increasing tumor complexity, quantitated by Nephrometry score (NS), is associated with increased complication rates following PN using the Clavien-Dindo classification system (CCS).
Methods: We queried our prospectively maintained kidney cancer database for patients undergoing PN for whom NS was available from 2007 to 2010. Tumors were categorized into low (NS 4-6), moderate (NS 7-9), and high (NS 10-12) complexity lesions. Complication rates within 30 days were graded (CCS I-V), stratified as minor (CCS I-II) or major (CCS III-V), and compared between groups.
Results: 390 patients (mean age 58.0+11.9yrs, 66.9% male) undergoing PN (44.6% open, 55.4% robotic) for low (28%), moderate (55.6%) and high (16.4%) complexity tumors (mean tumor size 3.74+2.4cm) from 2007-2010 were identified. Tumor size, EBL, and ischemia time all significantly differed (p<0.0001) between groups, while patient age, BMI, and operative time were comparable. Stratified by CCS, minor and major complication rates for all patients were 26.7% and 11.5%. Minor complication rates were comparable (26.6 vs. 24.9 vs. 32.8%, p=0.45), while major complication rates differed (6.4 vs. 11.1 vs. 21.9%; p=0.009) amongst tumor complexity groups. Controlling for age, gender, BMI, tumor size, operative time, and tumor complexity, prolonged operative time (OR 3.4, CI [1.6-7.1]) and high NS (OR 3.9, CI [1.4-10.9]) were associated with the postoperative development of a major complication.
Conclusions: Increasing tumor complexity is associated with the development of major complications after PN. This association should be validated externally and integrated into the decision-making process when counseling patients with complex renal tumors.