title: Analysis of surgical complications of renal tumor enucleation with standardized instruments and external validation of PADUA classification.
abstract: OBJECTIVE
  To assess surgical results and morbidity of tumor enucleation (TE), and to evaluate their correlation with PADUA nephrometric score.
  
  
  METHODS
  We prospectively gathered data, including accurate analysis of tumor nephrometry, from 244 consecutive patients treated with TE for clinically localized renal cell carcinoma. All surgical results were collected, and perioperative complications were stratified for severity according to Clavien system. Correlation between preoperative variables and surgical results/complications was assessed with uni- and multivariate analysis.
  
  
  RESULTS
  Mean (range) tumor size was 3.6 (0.8-10.0) cm, and mean (range) warm ischemia time was 16.8 (5-35) min. Overall, perioperative complications occurred in 45 patients (18.4 %), and of those 8 were medical and 37 were surgical (4 Clavien grade 1, 25 grade 2, and 8 grade 3) complications. Urine leakage rate was 2.0 %. No grade 4/5 complications occurred in this series. At univariate analysis PADUA score, endophytic tumor growth, tumor diameter, involvement of UCS and renal sinus resulted associated with warm ischemia time (p < 0.0001 each) and surgical complications (p = 0.0007, p = 0.049, p = 0.021, p = 0.036, and p = 0.029, respectively). At logistic regression, nephrometry score resulted independently associated with overall complications (related risk for each increased point 1.54; p = 0.017), surgical complications (related risk 1.58; p = 0.016), and Clavien grade 3 surgical complications (related risk 2.99; p = 0.008).
  
  
  CONCLUSIONS
  The TE technique was associated with a 15.2 % surgical complication rate with a 3.3 % reintervention rate (including ureteral stenting and superselective renal artery embolization). Tumor nephrometry and surgical indication resulted independent predictors of Clavien grade 3 complications. The PADUA score is a reliable tool to predict surgical results and morbidity of TE.
authors.affiliation: Department of Urology, University of Florence, Careggi Hospital, Florence, Italy. andreamine@libero.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
authors.forename: Gianni
authors.initials: G
authors.lastname: Vittori
authors.forename: Matteo
authors.initials: M
authors.lastname: Salvi
authors.forename: Arcangelo
authors.initials: A
authors.lastname: Sebastianelli
authors.forename: Agostino
authors.initials: A
authors.lastname: Tuccio
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Siena
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Masieri
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.forename: Alberto
authors.initials: A
authors.lastname: Lapini
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D011183:Postoperative Complications / Q000145:classification* / Q000209:etiology; D012086:Reoperation; D018709:Statistics, Nonparametric; D052096:Warm Ischemia