PROSPECTIVE ANALYSIS OF COMPLICATIONS AND THEIR PREDICTIVE FACTORS AFTER PARTIAL NEPHRECTOMY IN A MULTICENTER COMPARATIVE ITALIAN STUDY (RECORD1)

Introduction/Aim: Absence of surgical complications represents an important perioperative goal of partial nephrectomy (PN). The aim of this study was to analyse intra and post-operative complications related to nephron-sparing surgery (NSS) in clinical T1 renal tumors in a wide Italian multicentre dataset and search for possible predictive factors. Materials and Methods: Overall, 1,075 patients treated with NSS for clinical renal tumors, between January 2009 and December 2012, were prospectively recorded. Overall, X patients had open NSS, Y a laparoscopic and Z a robotic approach. Centres were divided in high- and low-volume according to the threshold of 50 interventions per year. A description of cT1 cases (n=965) and a uni- and multivariate analysis for surgical complication were performed. Results: Overall, 965 patients were analyzed. 4.9% had intraoperative complications (3% for pleural injuries, 1% for vascular injuries, 0.3% for spleen injuries and 0.6% for other causes). Overall, in 13.3% of patients, post-operative surgical complications were recoeded (7.6% surgical Clavien 2 and 3.8% surgical Clavien 3). Overall, 6.4% of patients had post-operative medical complications (3.2% were respiratory, 1.9% cardiologic, 0.2% thromboembolisms and 1.1% for other causes). At multivariate analysis, ECOG score ≥1 (odds ratio (OR)=1.9, 95% confidence interval (CI)=1.21-3.10, p=0.01), clinical diameter (OR=1.42, CI=0.1.07-1.90, p 0.02), open approach (OR=3.2, CI=1.11-9.30, p 0.03) and estimated blood loss (EBL) (OR=1.01, CI=1.00-1.01, p 0.01) were significant predictive factor of surgical post-operative complications. Intraoperative complications, at univariate analysis, were predictive factors for surgical post-operative complications (p=0.0001); however, they did not achieve significance at multivariate analysis (OR=2.08, CI=0.94-4.59, p=0.07). Conclusion: In this study, comorbidity status (ECOG score) and clinical diameter of the tumor were the only pre-operative significant predictive factors of surgical complications,