TITLE:
Partial Nephrectomy for Renal Cell Carcinoma: Risk Factors for Acute Post-Operative Hemorrhage and Impact on Subsequent Hospital Course and Complete Nephrectomy Rate. An Analysis of 200 Consecutive Cases
AUTHORS:
James Cavalcante, Alan Perrotti, Philip Rabadi, Alicia McCarthy, Michael Perrotti
KEYWORDS:
Kidney Neoplasms; Partial Nephrectomy; Renal Cell Carcinoma
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.4 No.12A,
December
24,
2013
ABSTRACT: Purpose: Clinical guidelines recommend partial nephrectomy (PN) as the preferred method
of surgical excision of
the small renal tumor whenever feasible. PN has comparable cancer cure rates to
that of radical nephrectomy in this setting, and decreased risk of chronic
kidney disease. A recognized devastating complication following partial nephrectomy
is acute post-operative
hemorrhage (APOH) from the
reconstructed kidney. Risk factors for hemorrhage following partial nephrectomy
remain poorly elucidated, as does the impact of hemorrhage on subsequent
hospital stay. Identification of risk factors for hemorrhage may lead to a
better understanding of and reduction of this complication. Material and Methods: We utilized a
prospectively managed database comprised of patients undergoing open partial
nephrectomy at our institution by the same surgical team from January 2006 to July 2012. Clinicopathologic
factors assessed APOH for their relationships, including patient age, gender,
diabetes, smoking, hypertension, coronary artery disease, American Society of
Anesthesia Score (ASA), tumor size, RENAL nephrotomy score, pathologic result,
cancer margin status, operative time, and intra-operative blood loss. The
impact of APOH on subsequent hospital course was evaluated and compared with the entire cohort. Results: Data were analyzed from 200
consecutive patients. We identified 7 patients (3.5%) who experienced APOH. Compared with the entire
cohort, APOH resulted in an
increased hospital length of stay (median, 5 days; range, 2-11 days, p = 0.001), an increased transfusion requirement
(median, 6 units; range, 1-16 units. p = 0.001), a greater risk of selective angiographic
embolization (median, 2 procedures; range, 0-3, p = 0.001), and completion nephrectomy (n = 2, p = 0.001). One patient in the APOH group
experienced cardiac arrest and was resuscitated. Clinicopathologic factors
associated with