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Prediction of Complications Following Partial Nephrectomy: Implications for Ablative Techniques Candidates

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Prediction of Complications Following Partial Nephrectomy: Implications for Ablative Techniques Candidates. / Larcher, Alessandro; Fossati, Nicola; Tian, Zhe; Boehm, Katharina; Meskawi, Malek; Valdivieso, Roger; Trudeau, Vincent; Dell'Oglio, Paolo; Buffi, Nicolò; Montorsi, Francesco; Guazzoni, Giorgio; Sun, Maxine; Karakiewicz, Pierre I.

In: EUR UROL, Vol. 69, No. 4, 20.07.2015, p. 676-682.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Larcher, A, Fossati, N, Tian, Z, Boehm, K, Meskawi, M, Valdivieso, R, Trudeau, V, Dell'Oglio, P, Buffi, N, Montorsi, F, Guazzoni, G, Sun, M & Karakiewicz, PI 2015, 'Prediction of Complications Following Partial Nephrectomy: Implications for Ablative Techniques Candidates', EUR UROL, vol. 69, no. 4, pp. 676-682. https://doi.org/10.1016/j.eururo.2015.07.003

APA

Larcher, A., Fossati, N., Tian, Z., Boehm, K., Meskawi, M., Valdivieso, R., Trudeau, V., Dell'Oglio, P., Buffi, N., Montorsi, F., Guazzoni, G., Sun, M., & Karakiewicz, P. I. (2015). Prediction of Complications Following Partial Nephrectomy: Implications for Ablative Techniques Candidates. EUR UROL, 69(4), 676-682. https://doi.org/10.1016/j.eururo.2015.07.003

Vancouver

Larcher A, Fossati N, Tian Z, Boehm K, Meskawi M, Valdivieso R et al. Prediction of Complications Following Partial Nephrectomy: Implications for Ablative Techniques Candidates. EUR UROL. 2015 Jul 20;69(4):676-682. https://doi.org/10.1016/j.eururo.2015.07.003

Bibtex

@article{f7b916ba25a64a0aa77267c2a74c7579,
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.DESIGN, SETTING, AND PARTICIPANTS: 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.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: 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.RESULTS AND LIMITATIONS: 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.PATIENT SUMMARY: 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.",
author = "Alessandro Larcher and Nicola Fossati and Zhe Tian and Katharina Boehm and Malek Meskawi and Roger Valdivieso and Vincent Trudeau and Paolo Dell'Oglio and Nicol{\`o} Buffi and Francesco Montorsi and Giorgio Guazzoni and Maxine Sun and Karakiewicz, {Pierre I}",
note = "Copyright {\textcopyright} 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.",
year = "2015",
month = jul,
day = "20",
doi = "10.1016/j.eururo.2015.07.003",
language = "English",
volume = "69",
pages = "676--682",
journal = "EUR UROL",
issn = "0302-2838",
publisher = "Elsevier",
number = "4",

}

RIS

TY - JOUR

T1 - Prediction of Complications Following Partial Nephrectomy: Implications for Ablative Techniques Candidates

AU - Larcher, Alessandro

AU - Fossati, Nicola

AU - Tian, Zhe

AU - Boehm, Katharina

AU - Meskawi, Malek

AU - Valdivieso, Roger

AU - Trudeau, Vincent

AU - Dell'Oglio, Paolo

AU - Buffi, Nicolò

AU - Montorsi, Francesco

AU - Guazzoni, Giorgio

AU - Sun, Maxine

AU - Karakiewicz, Pierre I

N1 - Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2015/7/20

Y1 - 2015/7/20

N2 - 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.DESIGN, SETTING, AND PARTICIPANTS: 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.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: 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.RESULTS AND LIMITATIONS: 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.PATIENT SUMMARY: 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.

AB - 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.DESIGN, SETTING, AND PARTICIPANTS: 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.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: 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.RESULTS AND LIMITATIONS: 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.PATIENT SUMMARY: 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.

U2 - 10.1016/j.eururo.2015.07.003

DO - 10.1016/j.eururo.2015.07.003

M3 - SCORING: Journal article

C2 - 26206408

VL - 69

SP - 676

EP - 682

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 4

ER -