MP24-09 RISK OF PSEUDOANEURYSM AND COMPLICATIONS AFTER PARTIAL NEPHRECTOMY: COMPARISON OF TUMOR ENUCLEATION TO STANDARD MARGIN TECHNIQUE

Abstract

You have accessJournal of UrologyCME1 May 2022MP24-09 RISK OF PSEUDOANEURYSM AND COMPLICATIONS AFTER PARTIAL NEPHRECTOMY: COMPARISON OF TUMOR ENUCLEATION TO STANDARD MARGIN TECHNIQUE Nicholas Elliott, Jae Han Lee, Hiten Patel, Whitney Halgrimson, Keshava Gali, Nicholas Lanzotti, Goran Rac, Marcus Quek, and Gopal Gupta Nicholas ElliottNicholas Elliott More articles by this author , Jae Han LeeJae Han Lee More articles by this author , Hiten PatelHiten Patel More articles by this author , Whitney HalgrimsonWhitney Halgrimson More articles by this author , Keshava GaliKeshava Gali More articles by this author , Nicholas LanzottiNicholas Lanzotti More articles by this author , Goran RacGoran Rac More articles by this author , Marcus QuekMarcus Quek More articles by this author , and Gopal GuptaGopal Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002563.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is the gold standard for the resection of amenable small renal masses. Some surgeons have adopted tumor enucleation (TE) over the standard margin PN (SPN) technique based on preservation of healthy renal parenchyma by following the tumor pseudocapsule. However, TE may also confer additional advantages due to avoidance of sharp incision including reduction in perioperative and bleeding complications. Therefore, we evaluated the rate of pseudoaneurysms and other complications following TE vs SPN. METHODS: A retrospective cohort study of patients undergoing PN (TE and SPN) between 2008 and 2020 was conducted. Baseline characteristics, comorbidities including chronic kidney disease and Charlson Comorbidity Index (CCI), prior surgical history, tumor size, clinical stage, and RENAL nephrometry score were captured. Clavien-Dindo complications including pseudoaneurysm were compared between the TE and SPN cohorts with univariable and multivariable logistic regression models. RESULTS: A total of 467 patients were included, 176 (37.7%) receiving TE and 291 (62.3%) SPN. There were no differences in baseline characteristics such as comorbidity, tumor size, clinical stage, or nephrometry score between groups. Conversion rates were similar but Clavien-Dindo complication rates were significantly less likely for TE with 19 (10.8%) compared to SPN with 68 (23.4%) (multivariable OR 2.55 (95%CI 1.45-4.51), p=0.001). Major Clavien-Dindo grade ≥3 complications were infrequent, but with notably lower rates for TE vs. SPN (2 (1.1%) vs. 22 (7.6%), multivariable OR 8.83 (95%CI 1.84-42.46), p=0.01). Reduction in bleeding complications was a major driver (1.7% vs. 6.2%, p=0.02) with no pseudoaneurysm events following TE compared to 13 following SPN (0.0% vs 2.8%, p=0.004). Need for interventional radiology largely reflected pseudoaneurysm differences (0 (0.0%) TE vs 14 (3.0%) SPN, p=0.003). Readmission occurred less often after TE vs. SPN (3.4% vs. 8.6%, p=0.03). CONCLUSIONS: Patients receiving TE experienced no clinically significant pseudoaneurysm formation and were less likely to have any bleeding complication or major Clavien-Dindo complication postoperatively. TE is a safe option for PN with avoidance of sharp excision optimizing perioperative parameters along with known benefits in renal function. TE may be preferred when minimizing morbidity aligns with patient selection and preferences. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e396 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Elliott More articles by this author Jae Han Lee More articles by this author Hiten Patel More articles by this author Whitney Halgrimson More articles by this author Keshava Gali More articles by this author Nicholas Lanzotti More articles by this author Goran Rac More articles by this author Marcus Quek More articles by this author Gopal Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...