Research Article| Volume 43, ISSUE 4, P823-830, April 2017

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Predictive factors of overall and major postoperative complications after partial nephrectomy: Results from a multicenter prospective study (The RECORd 1 project)

Published:November 04, 2016DOI:


      Introduction and objectives

      To analyze postoperative complications and to assess for significant predictive factors during partial nephrectomy (PN) using a large multicenter dataset.


      Patients who underwent PN for clinical T1 renal tumors at 19 urological Italian centers (Registry of Conservative Renal Surgery [RECORd] project) were evaluated between 2009 and 2012. Anthropometric data, comorbidities and perioperative outcomes were analyzed. Complications were divided as intra- and postoperative, medical and surgical, as appropriate. The severity of postoperative complications was graded according to the modified Clavien classification system. Patients who experienced intraoperative complications were excluded from the analyses for the potential confounding effect in the evaluation of predicting factors for postoperative complications.


      Overall, 979 patients were analyzed: open, laparoscopic and robot-assisted (available since 2011) surgical approaches were used in 522 (56.4%), 286 (30.9%) and 117 (12.6%) cases, respectively. Surgical postoperative complications were reported in 121 (13.1%) cases (32 (3.5%) were Clavien 3), medical were reported in 52 (5.6%) cases (3 (0.3%) were Clavien 3). No Clavien 4 complications were reported. At multivariable analysis, ECOG score ≥1 (OR 1.98; p = 0.002), lower preoperative hemoglobin (OR 0.71; p < 0.0001) and open surgical approach (2.91; p = 0.02) were significant predictive factors of overall surgical postoperative complications, ECOG score ≥1 (OR 1.93; p = 0.04) and surgical approach (p = 0.05) were significant predictive factors of Clavien 3 either surgical or medical postoperative complications.


      Comorbidities and surgical approach should be considered in preoperative evaluation of patients undergoing PN, as they resulted to play a significant role in the occurrence of postoperative complications.


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        • Znaor A.
        • Lortet-Tieulent J.
        • Laversanne M.
        International variations and trends in renal cell carcinoma incidence and mortality.
        Eur Urol. 2015 Mar; 67 (Epub 2014 Oct 16. Review): 519-530
        • Ljungberg B.
        • Bensalah K.
        • Canfield S.
        • et al.
        EAU guidelines on renal cell carcinoma: 2014 update.
        Eur Urol. 2015 May; 67 (Epub 2015 Jan 21): 913-924
        • Serni S.
        • Vittori G.
        • Frizzi J.
        • et al.
        Simple enucleation for the treatment of highly complex renal tumors: perioperative, functional and oncological results.
        Eur J Surg Oncol. 2015 Jul; 41: 934-940
        • Tanagho Y.S.
        • Kaouk J.H.
        • allaf M.E.
        • et al.
        Perioperative complications of robot-assisted partial nephrectomy: analysis of 886 patients at 5 United States centers.
        Urology. 2013 Mar; 81: 573-579
        • Hadjipavlou M.
        • Khan F.
        • Fowler S.
        Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit.
        BJU Int. 2015 Mar 6;
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications. A new proposal with evalutation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • 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 Nov; 56 (Epub 2009 Aug 4): 786-793
        • Schiavina R.
        • Mari A.
        • Antonelli A.
        A snapshot of nephron-sparing surgery in Italy: a prospective, multicenter report on clinical and perioperative outcomes (the RECORd 1 project).
        Eur J Surg Oncol. 2015 Mar; 41 (Epub 2014 Dec 27): 346-352
        • Oken M.M.
        • Creech R.H.
        • Tormey D.C.
        • et al.
        Toxicity and response criteria of the Eastern Cooperative Oncology Group.
        Am J Clin Oncol. 1982; 5: 649-655
        • Minervini A.
        • Ficarra V.
        • Rocco F.
        • et al.
        Simple enucleation is equivalent to traditional partial nephrectomy for renal cell carcinoma: results of a nonrandomized, retrospective, comparative study.
        J Urol. 2011 May; 185: 1604
        • Martin 2nd, R.C.
        • Brennan M.F.
        • Jaques D.P.
        Quality of complication reporting in the surgical literature.
        Ann Surg. 2002; 235: 803-813
        • Mitropoulos D.
        • Artibani W.
        • Biyani C.S.
        • et al.
        Quality assessment of partial nephrectomy complications reporting using EAU standardised quality criteria.
        Eur Urol. 2014; 66: 522-526
        • Capitanio U.
        • Terrone C.
        • Antonelli A.
        • et al.
        Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function.
        Eur Urol. 2014 Oct 2; (pii: S0302-2838(14) 00964-6)
        • Van Poppel H.
        • Da Pozzo L.
        • Albrecht W.
        • et al.
        A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma.
        Eur Urol. 2011 Apr; 59 (Epub 2010 Dec 22): 543-552
        • Larcher A.
        • Fossati N.
        • Tian Z.
        • et al.
        Prediction of complications following partial nephrectomy: implications for ablative techniques candidates.
        Eur Urol. 2015 Jul 20; (pii: S0302-2838(15)00607-7)
        • Antonelli A.
        • Minervini A.
        • Mari A.
        • et al.
        TriMatch comparison of the efficacy of FloSeal versus TachoSil versus no hemostatic agents for partial nephrectomy: results from a large multicenter dataset.
        Int J Urol. 2015; 22: 47-52
        • Hakimi A.A.
        • Rajpathak S.
        • Chery L.
        • et al.
        Renal insufficiency is an independent risk factor for complications after partial nephrectomy.
        J Urol. 2010; 183: 43-47
        • Ghani K.R.
        • Sukumar S.
        • Sammon J.D.
        • et al.
        Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the nationwide inpatient sample.
        J Urol. 2014 Apr; 191 (Epub 2013 Oct 29): 907-912
        • Mukkamala A.
        • Allam C.L.
        • Ellison J.S.
        • et al.
        Tumor enucleation vs sharp excision in minimally invasive partial nephrectomy: technical benefit without impact on functional or oncologic outcomes.
        Urology. 2014 Jun; 83 (Epub 2014 Apr 6): 1294-1299
        • Minervini A.
        • Carini M.
        • Uzzo R.G.
        • et al.
        Standardized reporting of resection technique during nephron-sparing surgery: the surface-intermediate-base margin score.
        Eur Urol. 2014 Nov; 66 (Epub 2014 Jun 18): 803-805
        • Serni S.
        • Vittori G.
        • Masieri L.
        • et al.
        Robotic vs open simple enucleation for the treatment of T1a-T1b renal cell carcinoma: a single center matched-pair comparison.
        Urology. 2014 Feb; 83 (Epub 2013 Nov 22): 331-337
        • Desantis D.
        • Lavallée L.T.
        • Witiuk K.
        • et al.
        The association between renal tumour scoring system components and complications of partial nephrectomy.
        Can Urol Assoc J. 2015 Jan-Feb; 9: 39-45