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Predictive factors of complications after robot‐assisted laparoscopic partial nephrectomy: a retrospective multicentre study
Author(s) -
Mathieu Romain,
Verhoest Gregory,
Droupy Stéphane,
Taille Alexandre,
Bruyere Franck,
Doumerc Nicolas,
Rischmann Pascal,
Vaessen Christophe,
Roupret Morgan,
Bensalah Karim
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12222
Subject(s) - medicine , nephrectomy , blood loss , body mass index , surgery , multivariate analysis , univariate analysis , retrospective cohort study , american society of anesthesiologists , hazard ratio , comorbidity , laparoscopy , charlson comorbidity index , confidence interval , kidney
Objective To analyse the predictive factors of complications after robot‐assisted laparoscopic partial nephrectomy ( RALPN ).Materials and Methods Data from six French institutions on 240 patients who underwent RALPN between 2009 and 2011 were retrospectively reviewed. Clinical (age, body mass index, A merican S ociety of A nesthesiologists and C harlson comorbidity index scores, anticoagulant treatment), tumoral (size, R . E . N . A . L nephrometry score) and operative (surgeon experience, blood loss, opening of the collecting system, operating time) variables were considered. Univariate and multivariate regression models were used to assess the impact of these variables on the occurrence of global and major postoperative complications, classified according to the Clavien system.Results The median (range) patient age was 61 (26–83) years. Tumours were of low complexity in 62% of cases. Median (range) operating time, blood loss and warm ischaemia time were 161 (45–425) min, 100 (0–2500) mL and 20 (0–59) min, respectively. Postoperative complications occurred in 79 (33%) patients. Complications were ≥grade III in 25 (10%) patients and were mostly haemorrhagic. In multivariate analysis, surgeon's experience (hazard ratio [ HR ]: 2.14 [1.07–4.27], P = 0.03) and blood loss ( HR : 1.002 [1.001–1.003], P < 0.001) were independent predictors of overall complications. When considering major complications, opening of the collecting system was the only factor that was significant ( OR : 2.99 [1.2–7.26], P = 0.02). Nephrometry R . E . N . A . L . score was not associated with postoperative complications.Conclusion In our experience, RALPN is associated with a 30% risk of postoperative complications; surgeon's experience, blood loss and opening of the collecting system were the three predictors of postoperative complications.