Predictive factors of complications in patients undergoing minimally invasive radical nephroureterectomy

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Conference Proceeding

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Eur Urol


Introduction & Objectives: This study aims to identify predictive complication risk factors of upper tract urothelial carcinoma (UTUC) after minimally invasive (laparoscopic or robotic assisted) nephroureterectomy (MIRNU).

Materials & Methods: We performed a multicenter, retrospective analysis of 1492 patients with UTUC who underwent MIRNU at 13 institutions across the United States, Europe, and Asia. Multivariate regression models were used to identify predictive factors for complication. We considered different risk factors, including patient characteristics [age, body mass index (BMI), American Society of Anesthesiologists (ASA)], tumor related factors (high risk vs low risk), and surgery related factors [operative time, estimated blood loss (EBL)]. Three different model for overall, major postoperative complication (≥ Clavien-Dindo III) and 30-days readmission rate, were assessed.

Results: A total of 1492 (821=Robot assisted; 671=laparoscopic) patients were included in analysis. Overall, 798 (53.5%) of patients developed (any grade) complications. There were 565 (37.9%), 179 (11.9%), 31 (2.1%), 11 (0.7%), and 12 (0.8%) in grade I, II, III, IV, V respectively. On multivariable analysis for overall post-operative complications, age [OR 1.02; CI 1-1.03; p=0.015], ASA score (≤2) [OR 0.12; CI 0.03-0.48; p=0.002], BMI (≤30) [OR: 0.93; CI (0.9-0.96); p<.001], high risk disease [OR 3.8; CI 1.001-1.004; p= 0.013], and EBL [OR: 1.003; CI 1.001-1.004; p<.001] were significant. When considering major complication, high risk disease [OR: 6.76; CI (1.12-40.5); p= 0.03] was the only predictor of perioperative complications. Considering 30-day readmission rate, age [OR: 1.02; CI 1-1.03; p= 0.01], ASA (≤2) [OR: 0.2; CI 0.045-0.9; p= 0.03], BMI (<30) [OR: 0.93; CI (0.8-0.9); p<.001], and EBL [OR: 1.003; CI (1.002-1.003); p<.001] were associated with an increased risk.

Conclusions: Patient related factors, cancer risk category and surgery related factors can play a role in the risk of complications after MIRNU. When it comes to high grade complications, high risk disease seems to be the most relevant factor. Risk of 30-day readmission seems to be driven by both patient characteristics and surgery related factors (EBL) with a lower BMI and ASA score having a protective effect against this risk.



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