The application of PADUA scoring system for predicting complications of laparoscopic renal cryoablation.

Abstract

To evaluate the clinical application of preoperative aspects and dimensions used for anatomical (PADUA) scoring system in predicting perioperative surgical outcomes in patients undergoing laparoscopic cryoablation (LCA). A total of 95 consecutive renal tumors treated with LCA between January 2007 and April 2013 were collected. Renal tumors were categorized into low- (6-7), moderate- (8-9), and high-complexity (10-13) groups according to PADUA indices. Demographics, perioperative variables, and complication rates were compared among three groups. Surgical conversion, blood loss >100 mL, tumor fracture, and incomplete ablation were regarded as intraoperative complications (IOCs). All postoperative complications (POCs) were graded using the Clavien-Dindo system. The risk for complications was assessed by univariate and multivariate logistic regression analyses. The estimated blood loss during LCA was associated with PADUA score. There were 17 (17.9%) IOCs and 20 (21.1%) POCs. Blood loss (>100 mL) was the most common IOC, which occurred in 10 (10.5%) patients. For POC, there were 15 (15.8%) minor complications (Clavien 1-2) and 5 (5.3%) major complications (Clavien 3a). Higher grade of PADUA scores was significantly correlated with the increase incidence of IOC and POC. The PADUA score was an independent predictive factor for POC, and the patients with moderate and high PADUA scores had an over sixfold and 17-fold higher risk compared to the patients with low scores, respectively. Our findings demonstrated, for the first time, the PADUA scoring system is an efficient assessment tool for predicting the perioperative complications in patients undergoing laparoscopic renal cryoablation.