達文西部分腎臟切除術後出血性併發症預測因子分析:專注於腫瘤直徑與深度

  邵翊紘、李宗霖、王翔生、陳明謙、張英勛、沈鼎文、黃亮鋼、甘弘成、劉忠一、林柏宏、虞凱傑、莊正鏗、馮思中、吳俊德

林口長庚紀念醫院泌尿科、長庚醫學大學、林口長庚紀念醫院病理部、新北土城長庚紀念醫院泌尿科、新北土城長庚紀念醫院影像醫學部

 Predicting Hemorrhagic Complications in Robotic-Assisted Partial Nephrectomy for Renal Tumors: Simplifying Risk Assessment with Tumor Diameter and Depth

  I-Hung Shao^1,2, Chung-Lin Lee¹, Hsiang-Sheng Wang³, Ming-Chien Chen², Ying-Hsu Chang^2,4, Ting-Wen Sheng^2,5, Liang-Kang Huang^1,2, Hung-Chen Kan^1,2, Chung-Yi Liu^2,4, Po-Hung Lin^1,2, Kai-Jie Yu^1,2, Cheng-Keng Chuang^1,2, See-Tong Pang^1,2, Chun-Te Wu^{1, 2}

¹ Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan

²Department of medicine, Chang Gung University, Taoyuan, Taiwan

³Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Kwei-Shan, Taoyuan 33305, Taiwan.

⁴Department of Urology, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, Taiwan

⁵Department of Medical Imaging and Intervention, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital, Taiwan

Purpose:

Robotic-assisted partial nephrectomy has become the primary approach for treating localized renal tumors. The most significant concern is the risk of hemorrhage. This study aims to identify a straightforward method for predicting hemorrhagic complications.

Materials and Methods:

We conducted a retrospective analysis of consecutive patients who underwent Robotic-assisted partial nephrectomy at a single tertiary medical center. Medical charts and computed tomography scan images were reviewed to collect clinical information. Tumor morphology data, including tumor diameter, depth, and nephrometry scores, were evaluated by a specialized radiologist. Hemorrhagic complications, such as intraoperative blood loss, perioperative blood transfusion, 2^nd surgery, and embolization were recorded. Statistical analyses for predictors of hemorrhagic complications were performed.

Results:

A total of 260 patients were enrolled in this study. The average PADUA and RENAL scores were 8.5 and 7.0, respectively. The mean tumor diameter was 39.1 mm, with a mean tumor depth of 2.02 mm and a median ischemia time of 25.5 minutes. Mean blood loss during surgery was 147 ml. In total, 12.7% of patients received peri-operative blood transfusions, while 3.5% of patients experienced major complications. Tumor diameter was the sole predictor for both intraoperative blood loss and perioperative blood transfusion, while tumor depth was significantly correlated with major bleeding complications.

Conclusion:

In comparison to the relatively complex nephrometry scoring system, tumor diameter and depth can easily predict hemorrhagic complications. These simple predictors can help clinicians implement appropriate interventions for patients at high risk of bleeding.