Department of Urology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
World J Urol. 2010 Aug;28(4):531-5. doi: 10.1007/s00345-010-0577-8. Epub 2010 Jul 7.
Ficarra et al. (Eur Urol 56:786-793, 2009) published a preoperative anatomical classification (PADUA) to assess the impact of anatomical parameters of renal tumors on complication rate of nephron-sparing surgery (NSS). The objective of this study is to provide a bi-center external validation of this classification using the technique of hilar arterial clamping during open and laparoscopic NSS and to correlate the PADUA score to the ischemia time.
240 consecutive tumors treated with open and laparoscopic NSS were reclassified according to the PADUA classification. Complications were graded according to the modified Clavien system (Dindo et al. in Ann Surg 240:205-213, 2004). Chi-square tests and multivariate logistic regression models addressed the predictive value of PADUA classification on overall complication rate and grade.
Mean patient age was 62.2 +/- 13.3 years. Eastern Cooperative Oncology Group performance was 0 in 76%, 1 in 22% and 2 in 2%. 61 (25%) were treated laparoscopically. The median PADUA score was 7.5 (range 6-13). Mean surgery and ischemia time was 189 +/- 95 and 24 +/- 22 min, respectively. Overall complication rate was 23% (n = 54). On univariate analysis, the PADUA score correlated with complication rate (p < 0.001) of open and laparoscopic NSS. On multivariate, only the PADUA score correlated with complication rate (p = 0.0056). Ischemic time correlated with the PADUA score and was significantly higher in PADUA score > or = 10 (p = 0.034).
The PADUA score is a reliable tool to preoperatively predict the risk of complications. In addition, it might be beneficial for a more objective patient selection for laparoscopic surgery and teaching NSS.
Ficarra 等人（《欧洲泌尿学》56:786-793，2009）发表了一种术前解剖分类（PADUA），以评估肾肿瘤解剖参数对保留肾单位手术（NSS）并发症发生率的影响。本研究的目的是使用开放和腹腔镜 NSS 中的肾门动脉夹闭技术对该分类进行双中心外部验证，并将 PADUA 评分与缺血时间相关联。
根据 PADUA 分类对 240 例接受开放和腹腔镜 NSS 治疗的连续肿瘤进行重新分类。并发症根据改良的 Clavien 系统（Dindo 等人，《外科学纪事》240:205-213，2004）进行分级。卡方检验和多变量逻辑回归模型分析了 PADUA 分类对总体并发症发生率和分级的预测价值。
患者平均年龄为 62.2 +/- 13.3 岁。东部肿瘤协作组表现为 0 级 76%，1 级 22%，2 级 2%。61 例（25%）接受腹腔镜治疗。中位 PADUA 评分为 7.5（范围 6-13）。手术和缺血时间的中位数分别为 189 +/- 95 和 24 +/- 22 分钟。总体并发症发生率为 23%（n = 54）。在单变量分析中，PADUA 评分与开放和腹腔镜 NSS 的并发症发生率相关（p < 0.001）。多变量分析仅 PADUA 评分与并发症发生率相关（p = 0.0056）。缺血时间与 PADUA 评分相关，在 PADUA 评分>或= 10 时显著升高（p = 0.034）。
PADUA 评分是术前预测并发症风险的可靠工具。此外，它可能有助于更客观地选择腹腔镜手术和教学 NSS 的患者。
