title: Prediction of Complications Following Partial Nephrectomy: Implications for Ablative Techniques Candidates.
abstract: BACKGROUND
  Current guidelines recommend local tumour ablation (LTA) over partial nephrectomy (PN) in nonsurgical candidates; however, objective definitions of these candidates are lacking.
  
  
  OBJECTIVE
  To identify specific patients who would benefit from LTA more than PN.
  
  
  METHODS
  A population-based assessment was performed of 2476 patients in the Surveillance Epidemiology and End Results-Medicare database who had cT1a kidney cancer treated with either LTA or PN, between 2000 and 2009.
  
  
  METHODS
  The outcome of the study was the relevant perioperative complications rate. A multivariable logistic regression model was fitted to predict the risk of complications after PN. Model-derived coefficients were used to calculate the risk of complication in case of PN among patients treated with LTA. Locally weighted scatterplot smoothing method was used to plot the observed complication rate against the predicted risk of complication in case of PN.
  
  
  CONCLUSIONS
  At multivariable logistic regression, age (odds ratio [OR]: 1.04; p<0.001), Charlson comorbidity index (OR: 1.14; p<0.001), acute kidney injury (OR: 1.91; p=0.04), or chronic kidney disease (OR: 2.16; p=0.002), tumour size (OR: 1.02; p=0.01), and minimally invasive approach (OR: 0.77; p<0.03) emerged as significant predictors of complications. When LTA was chosen over PN, the reduction in the risk of complications was greatest in high-risk patients, intermediate in intermediate-risk patients, and least in low-risk patients.
  
  
  CONCLUSIONS
  When postoperative complications are evaluated, the benefit of choosing LTA is not the same in all patients diagnosed with T1a kidney cancer. Specifically, patients at high risk of complications in case of PN may benefit the most from LTA and represent ideal LTA candidates.
  
  
  RESULTS
  Elderly patients at high risk of complications in case of surgical treatment with partial nephrectomy for kidney cancer should be instructed that local tumour ablation might decrease their perioperative morbidity.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: alelarcher@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Boehm
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: Malek
authors.initials: M
authors.lastname: Meskawi
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: Roger
authors.initials: R
authors.lastname: Valdivieso
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Trudeau
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dell'Oglio
authors.affiliation: Department of Urology, Humanitas Clinical and Research Center, Milan, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Buffi
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Urology, Humanitas Clinical and Research Center, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Urology, University of Montreal Health Center, Montreal, Canada.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Complications; Elderly patients; Kidney cancer; Local tumour ablation; Nephron-sparing surgery; Partial nephrectomy