Mp64-19 Factors Predicting Blood Loss and Positive Margins at Time of Partial Nephrectomy: Analysis of a Contemporary Cohort
Year: 2016
Type: article
Study design: Observational Study
Abstract: You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III1 Apr 2016MP64-19 FACTORS PREDICTING BLOOD LOSS AND POSITIVE MARGINS AT TIME OF PARTIAL NEPHRECTOMY: ANALYSIS OF A CONTEMPORARY COHORT Harras Zaid, Stephen Boorjian, William Parker, Christine Lohse, John Cheville, Bradley Leibovich, and R. Houston Thompson Harras ZaidHarras Zaid More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , William ParkerWilliam Parker More articles by this author , Christine LohseChristine Lohse More articles by this author , John ChevilleJohn Cheville More articles by this author , Bradley LeibovichBradley Leibovich More articles by this author , and R. Houston ThompsonR. Houston Thompson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.969AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) has become the treatment of choice for small renal masses. While obtaining negative margins with minimal blood loss are goals of PN, predictors of positive surgical margin (PSM) and transfusion requirement in contemporary patients are lacking. METHODS We performed a single-institution retrospective study evaluating all adult patients undergoing PN between 2001-2012 for non-hereditary renal masses at the Mayo Clinic. Univariable and multivariable logistic regression models were evaluated to assess clinicopathologic predictors of PSM and perioperative blood loss requiring transfusion. RESULTS We identified 1763 patients who underwent 1773 PNs between 2001-2012. Clinicopathologic variables are provided in the Table below by year (2001-2006 vs. 2007-2012). We identified 51 (3%) of PNs with a PSM. In a multivariable model, the following factors predicted PSM during PN: the presence of a solitary kidney (OR 3.81, p < 0.001), ECOG ≥ 1 (OR 2.33, p = 0.036), and robotic approach (OR 2.84, p = 0.006). A total of 258 (15%) patients were transfused during their hospitalization including 150 (8%) patients who required at least one unit of blood during surgery. In a multivariable analysis, several factors predicted need for transfusion: increasing age (OR 1.22, p = 0.006), solitary kidney (OR 2.02, p = 0.003), eGFR < 30 (OR 4.17, p < 0.001), higher Charlson score (OR 1.23, p < 0.001), and increasing tumor size (OR 1.25, p < 0.001); and the following features were associated with decreased need for transfusion: male gender (OR 0.61, p = 0.001), laparoscopic PN (OR 0.31, p = 0.001), and robotic PN (OR 0.25, p = 0.003). Year of surgery was not significantly associated with transfusion. CONCLUSIONS In this contemporary series, while robotic PN offered the advantage of fewer transfusions, it was associated with higher PSM. Furthermore, patients with solitary kidneys or significant co-morbidity undergoing PN were noted to be at higher risk for transfusion and PSM. Further evaluation, including longer term oncologic outcomes, are needed, though these data may be of value in counseling patients prior to surgery. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e838 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Harras Zaid More articles by this author Stephen Boorjian More articles by this author William Parker More articles by this author Christine Lohse More articles by this author John Cheville More articles by this author Bradley Leibovich More articles by this author R. Houston Thompson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Source: The Journal of Urology
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2314922191