The influence of renal nephrometry score on pre‑ruptured pseudoaneurysm formation in early postoperative period after minimally invasive partial nephrectomy
Authors:
T. Kondo; K. Omae; T. Takagi; S. Morita; Y. Hashimoto; H. Kobayashi; J. Iizuka; K. Yoshida; K. Tanabe
Published in the journal:
Urol List 2014; 12(2): 58-64
Summary
Objectives:
Renal artery pseudoaneurysm (RAP) can be a life threatening complication after partial nephrectomy. We investigated the incidence of unruptured RAP detected by 3- dimensional computed tomography arteriography (CTA) in the early period after minimally invasive partial nephrectomy (MIPN), including laparoscopic and robotic partial nephrectomy. We also examined the usefulness of nephrometry scoring system to predict the occurrence of RAP.
Methods:
From February 2012 to November 2013, 101 patients underwent MIPN for renal masses. CTA was performed 3– 4 days after surgery, and the radiologists made a diagnosis of RAP in the blinded manner. The factors influencing the occurrence of RAP were analyzed with the logistic regression model.
Results:
The incidence of RAP was unexpectedly high at 21.7% when detected by CTA in the early period after MIPN. The RAP group showed a significantly larger tumor size (p = 0.02) and a significantly higher N component score (p = 0.01) compared to the No- RAP group. However, Neither the sum of nephrometry score nor each component showed significant influence on the occurrence of RAP according to the multivariate analysis. Tumor size was the only significant independent factor to predict the occurrence of RAP after MIPN.
Conclusions:
The N component of the nephrometry scoring system is a significant predictor for RAP by the univariate analysis, but not by the multivariate analysis. The N component of the nephrometry scoring system may be referred to as one of the factors predicting the occurrence RAP.
Key words:
renal neoplasms nephrectomy, aneurysm, false, laparoscopy, robotics,
Zdroje
1. Novick AC, Campbell SC, Belldegrun A et al. Guideline for Management of the clinical stage 1 renal mass. USA: American Urological Association Education and Research, Linthicum 2009.
2. Ljungberg B, Cowan NC, Hanbury DC et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 2010; 58(3): 398– 406. doi: 10.1016/ j.eururo.2010.06.032.
3. Abukora F, Nambirajan T, Albqami N et al. Laparoscopic nephron sparing surgery: evolution in a decade. Eur Urol 2005; 47(4): 488– 493; discussion: 493.
4. Gill IS, Kavoussi LR, Lane BR et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 2007; 178(1): 41– 46.
5. Porpiglia F, Volpe A, Billia M et al. Laparoscopic versus open partial nephrectomy: analysis of the current literature. Eur Urol 2008; 53(4): 732– 742; discussion: 42– 43. doi: 10.1016/ j.eururo.2008.01.025.
6. Aboumarzouk OM, Stein RJ, Eyraud R et al. Robotic versus laparoscopic partial nephrectomy: a systematic review and meta‑analysis. Eur Urol 2012; 62(6): 1023– 1033. doi: 10.1016/ j.eururo.2012.06.038.
7. Patel HD, Mullins JK, Pierorazio PM et al. Trends in renal surgery: robotic technology is associated with increased use of partial nephrectomy. J Urol 2013; 189(4): 1229– 1235. doi: 10.1016/ j.juro.2012.10.024.
8. Ficarra V, Minervini A, Antonelli A et al. A multicentre matched- pair analysis comparing robot- assisted versus open partial nephrectomy. BJU Int 2013. doi: 10.1111/ bju.12570.
9. Albani JM, Novick AC. Renal artery pseudoaneurysm after partial nephrectomy: three case reports and a literature review. Urology 2003; 62(2): 227– 231.
10. Cohenpour M, Strauss S, Gottlieb P et al. Pseudoaneurysm of the renal artery following partial nephrectomy: imaging findings and coil embolization. Clin Radiol 2007; 62(11): 1104– 1109.
11. Netsch C, Brüning R, Bach T et al. Management of renal artery pseudoaneurysm after partial nephrectomy. World J Urol 2010; 28(4): 519– 524. doi: 10.1007/ s00345‑ 010‑ 0572‑ 0.
12. Ghoneim TP, Thornton RH, Solomon SB et al. Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy. J Urol 2011; 185(6): 2061– 2065. doi: 10.1016/ j.juro.2011.02.049.
13. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 2009; 182(3): 844– 853. doi: 10.1016/ j.juro.2009.05.035.
14. Simhan J, Smaldone MC, Tsai KJ et al. Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy. Eur Urol 2011; 60(4): 724– 730. doi: 10.1016/ j.eururo.2011.05.030.
15. Stroup SP, Palazzi K, Kopp RP et al. RENAL nephrometry score is associated with operative approach for partial nephrectomy and urine leak. Urology 2012; 80(1): 151– 156. doi: 10.1016/ j.urology.2012.04.026.
16. Takagi T, Kondo T, Tajima T et al. Enhanced computed tomography after partial nephrectomy in early postoperative period to detect asymptomatic renal artery pseudoaneurysm. Int J Urol 2014. doi: 10.1111/ iju.12462.
17. Sobin LH, Gospodarowicz M, Wittekind CH. Kidney (ICD– O C64). In: TNM classification of malignant tumours. 7th ed. New York: Wiley- Liss 2009: 255– 257.
18. Eble JN, Sauter G, Epstein JI et al. Classification of tumours: pathology and genetics of tumours of the urinary system and male genital organs. In: World Health Organization Classification of Tumours. Lyon, France: IARC Press 2004.
19. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240(2): 205– 213.
20. Gill IS, Desai MM, Kaouk JH et al. Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol 2002; 167(2 Pt 1): 469– 477; discussion: 475– 476.
21. Rogers CG, Singh A, Blatt AM et al. Robotic partial nephrectomy for complex renal tumors: surgical technique. Eur Urol 2008; 53(3): 514– 521.
22. Matsuo S, Imai E, Horio M et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 2009; 53(6): 982– 992. doi: 10.1053/ j.ajkd.2008.12.034.
23. Shapiro EY, Hakimi AA, Hyams ES et al. Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. Urology 2009; 74(4): 819– 823. doi: 10.1016/ j.urology.2009.03.056.
24. Hyams ES, Pierorazio P, Proteek O et al. Iatrogenic vascular lesions after minimally invasive partial nephrectomy: a multi‑institutional study of clinical and renal functional outcomes. Urology 2011; 78(4): 820– 826. doi: 10.1016/ j.urology.2011.04.063.
25. Jain S, Nyirenda T, Yates J et al. Incidence of renal artery pseudoaneurysm following open and minimally invasive partial nephrectomy: a systematic review and comparative analysis. J Urol 2013; 189(5): 1643– 1648. doi: 10.1016/ j.juro.2012.11.170.
26. Moore CJ, Rozen SM, Fishman EK. Two cases of pseudoaneurysm of the renal artery following laparoscopic partial nephrectomy for renal cell carcinoma: CT angiographic evaluation. Emerg Radiol 2004; 10(4): 193– 196.
27. Singh D, Gill IS. Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. J Urol 2005; 174(6): 2256– 2259.
28. Ficarra V, Novara G, Secco S et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron- sparing surgery. Eur Urol 2009; 56(5): 786– 793. doi: 10.1016/ j.eururo.2009.07.040.
29. Simmons MN, Ching CB, Samplaski MK et al. Kidney tumor location measurement using the C index method. J Urol 2010; 183(5): 1708– 1713. doi: 10.1016/ j.juro.2010.01.005.
30. Png KS, Bahler CD, Milgrom DP et al. The role of R.E.N.A.L. nephrometry score in the era of robot- assisted partial nephrectomy. J Endourol 2013; 27(3): 304– 308. doi: 10.1089/ end.2012.0182.
31. Mufarrij PW, Krane LS, Rajamahanty S et al. Does nephrometry scoring of renal tumors predict outcomes in patients selected for robot- assisted partial nephrectomy? J Endourol 2011; 25(10): 1649– 1653. doi: 10.1089/ end.2011.0003.
32. Nadu A, Kleinmann N, Laufer M et al. Laparoscopic partial nephrectomy for central tumors: analysis of perioperative outcomes and complications. J Urol 2009; 181(1): 42– 47; discussion: 47. doi: 10.1016/ j.juro.2008.09.014.
33. Liu ZW, Olweny EO, Yin G et al. Prediction of perioperative outcomes following minimally invasive partial nephrectomy: role of the R.E.N.A.L nephrometry score. World J Urol 2013; 31(5): 1183– 1189. doi: 10.1007/ s00345‑ 012‑ 0876‑ 3.
Štítky
Paediatric urologist UrologyČlánok vyšiel v časopise
Urological Journal
2014 Číslo 2
Najčítanejšie v tomto čísle
- Active approach to prostate cancer detection – what is reasonable and what may cause harm
- Prostate cancer – from hormonal dependency to castration resistant cancer
- Transrectal high-intensity focused ultrasound for the treatment of localized prostate cancer
- Erectile dysfunction and its treatment – pharmacological and clinical profile of avanafil