Iordache Alexandru, Ungureanu Claudiu-Octavian, Mareş Nicoleta-Alina, Ginghină Octav, Iordache Niculae
Chirurgia (Bucur). 2025 Jun;120(3):255-264. doi: 10.21614/chirurgia.3149.
The Preoperative Aspects and Dimensions Used for Anatomical Classification (PADUA) score was developed based on an algorithm incorporating anatomical characteristics and renal tumor size to predict surgical risk and perioperative complications in patients undergoing open nephrectomy. For the current study, we extended the application of the PADUA score to laparoscopic partial nephrectomy and analyzed the outcomes. Our study was based on a retrospective analysis of 94 patients who underwent partial nephrectomy at the Urology Department of Prof. Th. Burghele Clinical Hospital between 2020 and 2024. Two groups were analyzed: the first included 44 cases (54.5% male) treated laparoscopically (38 via transperitoneal and 6 via retroperitoneal approach), and the second included 50 cases (54% male) treated with open surgery via a lumbar approach. The mean age of patients in the open (OPN) and laparoscopic (LPN) groups was 64 and 61.2 years, respectively. We analyzed three variables in relation to the PADUA score: ischemia time, operative time, and body mass index (BMI). In the laparoscopic group, no correlation was found between ischemia time and operative time (p=0.655 and p=0.686, respectively). Similarly, no correlation was observed in the open group (p=0.882 and p=0.787, respectively). The PADUA score was significantly correlated with BMI in the laparoscopic group (p=0.023), but not in the open group (p=0.202). Regarding complications, the PADUA score was significantly associated with postoperative complications in the laparoscopic group (p=0.013), but not in the open group (p=0.287). Conclusion: The PADUA score was used to assess the complexity of renal tumor resection using both open and laparoscopic approaches. Our study demonstrated that a higher BMI is associated with a higher PADUA score, suggesting that obesity may increase the complexity of the laparoscopic approach in partial nephrectomy. Furthermore, in the laparoscopic group, a high PADUA score was significantly correlated with the occurrence of postoperative complications.
术前用于解剖学分类的相关因素及维度（PADUA）评分是基于一种结合解剖学特征和肾肿瘤大小的算法开发的，用于预测接受开放性肾切除术患者的手术风险和围手术期并发症。在本研究中，我们将PADUA评分的应用扩展至腹腔镜下部分肾切除术，并分析了其结果。我们的研究基于对2020年至2024年期间在Th. Burghele教授临床医院泌尿外科接受部分肾切除术的94例患者的回顾性分析。分析了两组：第一组包括44例（54.5%为男性）接受腹腔镜手术治疗的患者（38例经腹腔途径，6例经腹膜后途径），第二组包括50例（54%为男性）经腰部途径接受开放手术治疗的患者。开放手术（OPN）组和腹腔镜手术（LPN）组患者的平均年龄分别为64岁和61.2岁。我们分析了与PADUA评分相关的三个变量：缺血时间、手术时间和体重指数（BMI）。在腹腔镜组中，未发现缺血时间与手术时间之间存在相关性（分别为p = 0.655和p = 0.686）。同样，在开放手术组中也未观察到相关性（分别为p = 0.882和p = 0.787）。在腹腔镜组中，PADUA评分与BMI显著相关（p = 0.023），但在开放手术组中无相关性（p = 0.202）。关于并发症，PADUA评分在腹腔镜组中与术后并发症显著相关（p = 0.013），但在开放手术组中无相关性（p = 0.287）。结论：PADUA评分用于评估开放性和腹腔镜手术两种方式下肾肿瘤切除的复杂性。我们的研究表明，较高的BMI与较高的PADUA评分相关，提示肥胖可能增加腹腔镜下部分肾切除术的复杂性。此外，在腹腔镜组中，高PADUA评分与术后并发症的发生显著相关。
