https://doi.org/10.4081/aiua.2021.3.251

Prediction of post radical nephrectomy complications based on patient comorbidity preoperatively

Vol. 93 No. 3 (2021)
Submitted: July 29, 2021
Accepted: August 22, 2021
Published: September 30, 2021
Nephrectomy, Comorbidity, Complication, Clavien Dindo, Charlson
Abstract Views: 977
PDF: 401
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Evangelos Fragkiadis
e.fragkiadis@gmail.com
1st Urology Department Univesity of Athens Laiko Hospital, Athens, Greece.
Christos Alamanis
1st Urology Department Univesity of Athens Laiko Hospital, Athens, Greece.
Constantinos A. Constantinides
1st Urology Department Univesity of Athens Laiko Hospital, Athens, Greece.
Dionysios Mitropoulos
1st Urology Department Univesity of Athens Laiko Hospital, Athens, Greece.

Objectives: Comorbidity along with tumor and patient characteristics is taken into account when deciding for the surgical treatment of renal cell carcinoma (RCC). Comorbidity has also been used as an independent predictive factor for postoperative complications of several major urological procedures including radical nephrectomy for RCC. The aim of the present study was to objectively evaluate the association between comorbidity and postoperative complications after radical nephrectomy for RCC, using standardized systems to grade both comorbidity and severity of postoperative complications.
Materials and methods: Clinicopathological data of 171 patients undergoing open radical nephrectomy for lesions suspected of RCC were prospectively recorded for a period of 3 years. Comorbidity was scored using the Charlson Comorbidity Index (CCI) while postoperative complications were graded according to the Clavien-Dindo system.
Results: Patients were predominantly males (59.1%); their age ranged from 35 to 88 years (mean ± SD: 63.6 ± 11.9 yrs) with 50.8% of them being ≤ 65 yrs. CCI ranged from 0 to 8 with the majority (85.3%) scoring ≤ 2. The procedure was uncomplicated in 57.3% cases; 10 patients suffered major (grade III/IV) complications and 4 patients died within the 40 days postoperative period. CCI correlated with the manifestation of any postoperative complication, Clavien ≥ 1, OR (95% CI): 1.47 (1.09-1.96), p = 0.011 and the occurrence of severe complications, Clavien > 2. OR (95% CI): 1.29 (1.01-1.63), p = 0.038.
Conclusions: The present prospective study showed that considerable complications occur in patients with major comorbidities. CCI is easily calculated and should be incorporated in preoperative consultation especially in cases of elder patients with severe comorbidity and favorable tumor characteristics where less invasive interventions or even active surveillance could be applied.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. Eur Urol. 2019; 75:799-810. DOI: https://doi.org/10.1016/j.eururo.2019.02.011
Heng DY, Xie W, Regan MM, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol. 2009; 27:5794-9. DOI: https://doi.org/10.1200/jco.2009.27.15_suppl.5041
Santos Arrontes D, Fernandez Acenero MJ, Garcia Gonzalez JI, et al. Survival analysis of clear cell renal carcinoma according to the Charlson comorbidity index. J Urol. 2008; 179:857-61. DOI: https://doi.org/10.1016/j.juro.2007.10.048
Kutikov A, Egleston BL, Wong YN, Uzzo RG. Evaluating overall survival and competing risks of death in patients with localized renal cell carcinoma using a comprehensive nomogram. J Clin Oncol. 2010; 28:311-7. DOI: https://doi.org/10.1200/JCO.2009.22.4816
Thomas M, George NA, Gowri BP, et al. Comparative evaluation of ASA classification and ACE-27 index as morbidity scoring systems in oncosurgeries. Indian J Anaesth. 2010; 54:219-25. DOI: https://doi.org/10.4103/0019-5049.65366
Post PN, Hansen BE, Kil PJ et al. The independent prognostic value of comorbidity among men aged < 75 years with localized prostate cancer: a population-based study. BJU Int. 2001; 87:821-826. DOI: https://doi.org/10.1046/j.1464-410x.2001.02189.x
Svatek RS, Fisher MB, Matin SF, et al. Risk factor analysis in a contemporary cystectomy cohort using standardized reporting methodology and adverse event criteria. J Urol. 2010; 183:929-34. DOI: https://doi.org/10.1016/j.juro.2009.11.038
Hennus PML, Kroeze SGC, Bosch JLHR, Jans JJM. Impact of comorbidity on complications after nephrectomy: use of the Clavien classification of surgical complications. BJU Int. 2012; 110:682-687. DOI: https://doi.org/10.1111/j.1464-410X.2011.10889.x
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987; 40:373-383. DOI: https://doi.org/10.1016/0021-9681(87)90171-8
Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidem. 1994;47:1245-1251. DOI: https://doi.org/10.1016/0895-4356(94)90129-5
de Groot V, Beckerman H, Lankhorst G, Bouter L. How to measure comorbidity: a critical review of available methods. J Clin Epidemiol. 2003; 56:221-229. DOI: https://doi.org/10.1016/S0895-4356(02)00585-1
Kutikov A, Egleston BL, Canter D, et al. Competing risks of death in patients with localized renal cell carcinoma: a comorbidity based model. J Urol. 2012; 188:2077-2083. DOI: https://doi.org/10.1016/j.juro.2012.07.100
Mitropoulos D, Artibani W, Graefen M, et al. European Association of Urology Guidelines Panel. Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol. 2012;61:341-9. DOI: https://doi.org/10.1016/j.eururo.2011.10.033
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindoclassification of surgical complications: five-year experience. Ann Surg. 2009; 250:187-196. DOI: https://doi.org/10.1097/SLA.0b013e3181b13ca2
Mitropoulos D, Artibani W, Biyani CS, Jensen JB, Roupret M, Truss M. Validation of the Clavien-Dindo grading system in Urology by the EAU guidelines ad hoc panel. European Urology Focus 2018; 4:608-613. DOI: https://doi.org/10.1016/j.euf.2017.02.014
Watanabe D, Miura K, Yamashita A, et al. A Comparison of the Predictive Role of the Geriatric Nutritional Risk Index and Immunonutritional Parameters for Postoperative Complications in Elderly Patients with Renal Cell Carcinoma. J Invest Surg. 2020;1-6. DOI: https://doi.org/10.1080/08941939.2020.1762808
Lue K, Russell CM, Fisher J, et al. Predictors of Postoperative Complications in Patients Who Undergo Radical Nephrectomy and IVC Thrombectomy: A Large Contemporary Tertiary Center Analysis. Clinical Genitourinary Cancer. 2016; 14:89-95. DOI: https://doi.org/10.1016/j.clgc.2015.09.007
Trudeau V, Larcher A, Boehm K, et al. Comparison of postoperative complications and mortality between laparoscopic and percutaneous local tumor ablation for T1a renal cell carcinoma: a population-based study. Urology. 2016; 89:63-7. DOI: https://doi.org/10.1016/j.urology.2015.08.043
Lund L, Jacobsen J, Norgaard M, et al. The prognostic impact of comorbidities on renal cancer, 1995 to 2006: a Danish population based study. J Urol. 2006; 182:35-40. DOI: https://doi.org/10.1016/j.juro.2009.02.136

How to Cite

Fragkiadis, E., Alamanis , C. ., Constantinides , C. A., & Mitropoulos , D. . (2021). Prediction of post radical nephrectomy complications based on patient comorbidity preoperatively. Archivio Italiano Di Urologia E Andrologia, 93(3), 251–254. https://doi.org/10.4081/aiua.2021.3.251

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.