Perioperative complications of robot-assisted partial nephrectomy: Analysis of 886 patients at 5 United States centers

Youssef S. Tanagho, Jihad H. Kaouk, Mohamad E Allaf, Craig G. Rogers, Michael D. Stifelman, Bartosz F. Kaczmarek, Shahab P. Hillyer, Jeffrey K. Mullins, Yichun Chiu, Sam B. Bhayani

Research output: Contribution to journalArticle

Abstract

Objective: To review complications of robot-assisted partial nephrectomy (RAPN) at 5 centers, as classified by the Clavien system. Materials and Methods: A multi-institutional analysis of prospectively maintained databases assessed RAPN complications. From June 2007 to November 2011, 886 patients at 5 United States centers underwent RAPN. Patient demographics, perioperative outcomes, and complications data were collected. Complication severity was classified by Clavien grade. Results: Mean (standard deviation) data were patient age, 59.4 (11.4) years; age-adjusted Charlson Comorbidity Index, 3.0 (1.9); radiographic tumor size, 3.0 (1.6) cm; nephrometry score, 6.9 (2.0); and warm ischemia time, 18.8 (9.0) minutes. Median blood loss was 100 mL (interquartile range, 100-250 mL). Of the 886 patients, intraoperative complications occurred in 23 patients (2.6%) and 139 postoperative complications occurred in 115 patients (13.0%) for a total complication rate of 15.6%. Among the 139 postoperative complications, 43 (30.9%) were classified as Clavien 1, 64 (46.0%) were Clavien 2, 21 (15.1%) were Clavien 3, and 11 (7.9%) were Clavien 4. No complication-related deaths occurred. Intraoperative hemorrhage occurred in 9 patients (1.0%) and postoperative hemorrhage in 51 (5.8%). Forty-one patients (4.6%) required a perioperative blood transfusion, 10 (1.1%) required angioembolization, and 2 (0.2%) required surgical reexploration for postoperative hemorrhage. Urine leaks developed in 10 patients (1.1%): 3 (0.3%) required ureteral stenting, and 2 (0.2%) required percutaneous drainage. Acute postoperative renal insufficiency or renal failure developed in 7 patients (0.8%), 2 of whom required hemodialysis. The RENAL (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior descriptor and the location relative to polar lines) nephrometry scoring system accurately predicted RAPN complication rates. Conclusion: Complication rates in this large multicenter series of RAPN appear to be acceptable and comparable with other nephron-sparing modalities. Most complications (77.0%) are Clavien 1 and 2 and can be managed conservatively.

Original languageEnglish (US)
Pages (from-to)573-579
Number of pages7
JournalUrology
Volume81
Issue number3
DOIs
StatePublished - Mar 2013
Externally publishedYes

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Nephrectomy
Postoperative Hemorrhage
Warm Ischemia
Neoplasms
Nephrons
Intraoperative Complications
Acute Kidney Injury
Blood Transfusion
Renal Insufficiency
Renal Dialysis
Comorbidity
Drainage
Demography
Urine
Databases
Hemorrhage

ASJC Scopus subject areas

  • Urology

Cite this

Tanagho, Y. S., Kaouk, J. H., Allaf, M. E., Rogers, C. G., Stifelman, M. D., Kaczmarek, B. F., ... Bhayani, S. B. (2013). Perioperative complications of robot-assisted partial nephrectomy: Analysis of 886 patients at 5 United States centers. Urology, 81(3), 573-579. https://doi.org/10.1016/j.urology.2012.10.067

Perioperative complications of robot-assisted partial nephrectomy : Analysis of 886 patients at 5 United States centers. / Tanagho, Youssef S.; Kaouk, Jihad H.; Allaf, Mohamad E; Rogers, Craig G.; Stifelman, Michael D.; Kaczmarek, Bartosz F.; Hillyer, Shahab P.; Mullins, Jeffrey K.; Chiu, Yichun; Bhayani, Sam B.

In: Urology, Vol. 81, No. 3, 03.2013, p. 573-579.

Research output: Contribution to journalArticle

Tanagho, YS, Kaouk, JH, Allaf, ME, Rogers, CG, Stifelman, MD, Kaczmarek, BF, Hillyer, SP, Mullins, JK, Chiu, Y & Bhayani, SB 2013, 'Perioperative complications of robot-assisted partial nephrectomy: Analysis of 886 patients at 5 United States centers', Urology, vol. 81, no. 3, pp. 573-579. https://doi.org/10.1016/j.urology.2012.10.067
Tanagho, Youssef S. ; Kaouk, Jihad H. ; Allaf, Mohamad E ; Rogers, Craig G. ; Stifelman, Michael D. ; Kaczmarek, Bartosz F. ; Hillyer, Shahab P. ; Mullins, Jeffrey K. ; Chiu, Yichun ; Bhayani, Sam B. / Perioperative complications of robot-assisted partial nephrectomy : Analysis of 886 patients at 5 United States centers. In: Urology. 2013 ; Vol. 81, No. 3. pp. 573-579.
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abstract = "Objective: To review complications of robot-assisted partial nephrectomy (RAPN) at 5 centers, as classified by the Clavien system. Materials and Methods: A multi-institutional analysis of prospectively maintained databases assessed RAPN complications. From June 2007 to November 2011, 886 patients at 5 United States centers underwent RAPN. Patient demographics, perioperative outcomes, and complications data were collected. Complication severity was classified by Clavien grade. Results: Mean (standard deviation) data were patient age, 59.4 (11.4) years; age-adjusted Charlson Comorbidity Index, 3.0 (1.9); radiographic tumor size, 3.0 (1.6) cm; nephrometry score, 6.9 (2.0); and warm ischemia time, 18.8 (9.0) minutes. Median blood loss was 100 mL (interquartile range, 100-250 mL). Of the 886 patients, intraoperative complications occurred in 23 patients (2.6{\%}) and 139 postoperative complications occurred in 115 patients (13.0{\%}) for a total complication rate of 15.6{\%}. Among the 139 postoperative complications, 43 (30.9{\%}) were classified as Clavien 1, 64 (46.0{\%}) were Clavien 2, 21 (15.1{\%}) were Clavien 3, and 11 (7.9{\%}) were Clavien 4. No complication-related deaths occurred. Intraoperative hemorrhage occurred in 9 patients (1.0{\%}) and postoperative hemorrhage in 51 (5.8{\%}). Forty-one patients (4.6{\%}) required a perioperative blood transfusion, 10 (1.1{\%}) required angioembolization, and 2 (0.2{\%}) required surgical reexploration for postoperative hemorrhage. Urine leaks developed in 10 patients (1.1{\%}): 3 (0.3{\%}) required ureteral stenting, and 2 (0.2{\%}) required percutaneous drainage. Acute postoperative renal insufficiency or renal failure developed in 7 patients (0.8{\%}), 2 of whom required hemodialysis. The RENAL (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior descriptor and the location relative to polar lines) nephrometry scoring system accurately predicted RAPN complication rates. Conclusion: Complication rates in this large multicenter series of RAPN appear to be acceptable and comparable with other nephron-sparing modalities. Most complications (77.0{\%}) are Clavien 1 and 2 and can be managed conservatively.",
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T1 - Perioperative complications of robot-assisted partial nephrectomy

T2 - Analysis of 886 patients at 5 United States centers

AU - Tanagho, Youssef S.

AU - Kaouk, Jihad H.

AU - Allaf, Mohamad E

AU - Rogers, Craig G.

AU - Stifelman, Michael D.

AU - Kaczmarek, Bartosz F.

AU - Hillyer, Shahab P.

AU - Mullins, Jeffrey K.

AU - Chiu, Yichun

AU - Bhayani, Sam B.

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N2 - Objective: To review complications of robot-assisted partial nephrectomy (RAPN) at 5 centers, as classified by the Clavien system. Materials and Methods: A multi-institutional analysis of prospectively maintained databases assessed RAPN complications. From June 2007 to November 2011, 886 patients at 5 United States centers underwent RAPN. Patient demographics, perioperative outcomes, and complications data were collected. Complication severity was classified by Clavien grade. Results: Mean (standard deviation) data were patient age, 59.4 (11.4) years; age-adjusted Charlson Comorbidity Index, 3.0 (1.9); radiographic tumor size, 3.0 (1.6) cm; nephrometry score, 6.9 (2.0); and warm ischemia time, 18.8 (9.0) minutes. Median blood loss was 100 mL (interquartile range, 100-250 mL). Of the 886 patients, intraoperative complications occurred in 23 patients (2.6%) and 139 postoperative complications occurred in 115 patients (13.0%) for a total complication rate of 15.6%. Among the 139 postoperative complications, 43 (30.9%) were classified as Clavien 1, 64 (46.0%) were Clavien 2, 21 (15.1%) were Clavien 3, and 11 (7.9%) were Clavien 4. No complication-related deaths occurred. Intraoperative hemorrhage occurred in 9 patients (1.0%) and postoperative hemorrhage in 51 (5.8%). Forty-one patients (4.6%) required a perioperative blood transfusion, 10 (1.1%) required angioembolization, and 2 (0.2%) required surgical reexploration for postoperative hemorrhage. Urine leaks developed in 10 patients (1.1%): 3 (0.3%) required ureteral stenting, and 2 (0.2%) required percutaneous drainage. Acute postoperative renal insufficiency or renal failure developed in 7 patients (0.8%), 2 of whom required hemodialysis. The RENAL (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior descriptor and the location relative to polar lines) nephrometry scoring system accurately predicted RAPN complication rates. Conclusion: Complication rates in this large multicenter series of RAPN appear to be acceptable and comparable with other nephron-sparing modalities. Most complications (77.0%) are Clavien 1 and 2 and can be managed conservatively.

AB - Objective: To review complications of robot-assisted partial nephrectomy (RAPN) at 5 centers, as classified by the Clavien system. Materials and Methods: A multi-institutional analysis of prospectively maintained databases assessed RAPN complications. From June 2007 to November 2011, 886 patients at 5 United States centers underwent RAPN. Patient demographics, perioperative outcomes, and complications data were collected. Complication severity was classified by Clavien grade. Results: Mean (standard deviation) data were patient age, 59.4 (11.4) years; age-adjusted Charlson Comorbidity Index, 3.0 (1.9); radiographic tumor size, 3.0 (1.6) cm; nephrometry score, 6.9 (2.0); and warm ischemia time, 18.8 (9.0) minutes. Median blood loss was 100 mL (interquartile range, 100-250 mL). Of the 886 patients, intraoperative complications occurred in 23 patients (2.6%) and 139 postoperative complications occurred in 115 patients (13.0%) for a total complication rate of 15.6%. Among the 139 postoperative complications, 43 (30.9%) were classified as Clavien 1, 64 (46.0%) were Clavien 2, 21 (15.1%) were Clavien 3, and 11 (7.9%) were Clavien 4. No complication-related deaths occurred. Intraoperative hemorrhage occurred in 9 patients (1.0%) and postoperative hemorrhage in 51 (5.8%). Forty-one patients (4.6%) required a perioperative blood transfusion, 10 (1.1%) required angioembolization, and 2 (0.2%) required surgical reexploration for postoperative hemorrhage. Urine leaks developed in 10 patients (1.1%): 3 (0.3%) required ureteral stenting, and 2 (0.2%) required percutaneous drainage. Acute postoperative renal insufficiency or renal failure developed in 7 patients (0.8%), 2 of whom required hemodialysis. The RENAL (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior descriptor and the location relative to polar lines) nephrometry scoring system accurately predicted RAPN complication rates. Conclusion: Complication rates in this large multicenter series of RAPN appear to be acceptable and comparable with other nephron-sparing modalities. Most complications (77.0%) are Clavien 1 and 2 and can be managed conservatively.

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