Category: Laparoscopic/ Robotic: Other

MP25-4 - Predictive factors of hemorrhagic complications after laparoscopic partial nephrectomy

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

Complication rates of laparoscopic partial nephrectomy (LPN) lie between 10 and 50%, according to tumor complexity. The most frequent complications of LPN are hemorrhagic (HC) and can lead to a need for transfusion, embolization and/or reoperation that can raise morbidity and increase length of hospital stay,


The objective was to evaluate predictive factors for HC after LPN in a contemporary cohort of patients.


Methods :

We retrospectively analyzed the data of 97 patients with RCC who underwent LPN between January 2008 and September 2017, with a median follow up time of 46.5 months, by a single surgeon in his learning curve of LPN. LPN was performed via transperitoneal approach.


HC was defined as a conversion to open surgery for bleeding control, postoperative active bleeding, an arteriovenous fistula (AVF) or renal artery pseudoaneurysm (PA), and as well as a postoperative need for blood transfusion or a hematoma requiring transfusion.


Preoperative, intraoperative and postoperative data were recorded and analyzed to evaluate vascular complications (Clavien classification). Patients with or without HC were compared using ANOVA and Chi-square tests for continuous and categorical variables, respectively. Univariate and multivariate analysis were performed using logistic regression including variables with statistical significance (p<0.05) and a tendency to significance (p≤0.11), which might influence as predictors of HC.


Results :

56.7% of the patients were men with a median age of 63 years. The mean estimated blood loss (EBL) and difference of postoperative and preoperative hemoglobin was 407.8 ml and 2.94 g/dl respectively. 22.7% of patients required postoperative transfusion.


The overall rate of intraoperative and postoperative complications were 21.7 and 48.5% respectively. Of the 47 patients with complications, 22(46.8%) were of vascular cause (3 conversion to open surgery, 1 AVF, 4 AP, 2 postoperative active bleeding and 12 blood tranfusions).

In the univariate analysis previous abdominal surgery (p=0.06), anticoagulant treatment (p=0.03), ASA ≥3 (p=0.04), PADUA score (p=0.1),  sinus infiltration (p=0.05) and EBL >400 ml (p=0.04) were identified as variables related to HC. In the multivariate analysis only anticoagulant treatment (p=0.03) and EBL >400 ml (p=0.04) were identified as predictive factors of HC, although the PADUA score showed a tendency towards significance (p=0.08).


Conclusions : Our rate of postoperative vascular and general complications are similar to those described in other studies. A previous anticoagulant treatment and EBL >400 ml appear to be predictive factors for the development of HC after LPN.

Ignacio T. Castillón Vela

Staff urologist
H.U. Puerta de Hierro. Majadahonda
Villaviciosa de Odón, Madrid, Spain

IGNACIO T. CASTILLÓN VELA M.D, PhD
Consultant Urologist. Department of Urology.
Hospital Universitario Puerta de Hierro Majadahonda
H.U. Madrid Torrelodones.
Director
Escuela Europea de Laparoscopia Urológica. Madrid
Schooloflaparoscopy.org


1984-1990 Doctor of Medicine. Universidad Autónoma de Madrid
1992-1997 Urology Residency. Department of Urology. Fundación Jiménez Díaz. Madrid.
1998. Certificate. Educational Comission for Foreign Medical Graduates (ECFMG).
2/1999- 1/2001 Clinical Fellow in Kidney and Pancreas Tansplantation
National Institute of Transplantation - St Vincent Medical Center. Departament of Urology. University of Southern California (USC). Los Ángeles, California. EEUU.
2001 PhD in Medicine and Surgery. Universidad Autónoma de Madrid.
2005-2006 Master in Medical Direction and Clinical Management Universidad Nacional de Educación a Distancia (UNED)
2008 University Expert Certificate in “E learning 2.0: Internet Education and On line training". Universidad Nacional de Educación a Distancia (UNED)
2009 Accreditation as Da Vinci Robot Console Surgeon.

Editor of 4 Books
Author in 5 chapters in urological Books
Editor/Author of 9 Audiovisual Projects
27 Articles in indexed Journals
85 Panel Presentations in Urological Meetings
114 Podium/Poster/Video presentations at urological meetings.

Reviewer for the following Journals:
- Archivos Españoles de Urología
- Urology
- Journal of Endourology
Reviewer for the selection commitee:
- Spanish AEU Annual Meeting
- European Association of Urology (EAU) Annual Meeting

Gema Del Pozo Jiménez

Staff Urologist
University Hospital Puerta de Hierro, Majadahonda.
Madrid, Madrid, Spain

1. EDUCATION:
- 2003-2009: Doctor of Medicine and Surgery (MD). University of Alcalá, Madrid, with a final grade of Honours.
- 2010-2015: Urology Residency. General University Hospital Gregorio Marañón, Madrid.
- 2013-2017: Degree in Design and Statistics in Health Sciences. Autonoma University of Barcelona.
- November, 2014: European Board of Urology (EBU) Online Written Examination. Madrid.
- June, 2015: European Board of Urology (EBU) Oral Examination. Brussels.
- 2013-2017: PhD. Complutense University of Madrid with mention of "Cum laude" with the title: Predictive model of mortality in patients with transitional bladder cancer treated with radical cystectomy.
- October 2017: Enrollment in the Master in Health Research Methodology. Autonoma University of Barcelona.
- January-May 2018: University Title of Expert in Urooncology of the Autonoma University of Madrid,
- Currently working as FEA of Urology since June 2015 in Puerta de Hierro University Hospital (Majadahonda), as well as a private activity in H.U. La Zarzuela and H. University H.M. Torrelodones.
2. - TEACHING:
• Practical teaching in the subject of Urology of the Autonoma University of Madrid in H.U.Puerta de Hierro (2015-2018).
• Online teaching as a professor in the course of laparoscopic and robotic radical cystectomy (1st Edition) of the European School of Urological Laparoscopy (2018).
3.-PUBLICATIONS IN JOURNALS: Five publications as author, four publications as co-author (three in Spanish Archives of Urology and one chapter of the Urology Resident's Book (Internet)) and four abstracts of European and world congresses, three as author and one as co-author (European Urology Supplements and Journal of Endourology).
4- COMMUNICATIONS PRESENTED AT NATIONAL CONGRESS: As author 32 papers: Eighteen papers and as co-author 36 co-author papers.
5- SUBMITTED VIDEOS IN CONGRESS: 14 videos as author and 6 videos as co-author.
6-COMMUNICATIONS/VIDEOS PRESENTED AT INTERNATIONAL CONGRESS: As author (9 presentations) and as co-author (4 presentations).

Alfonso Gimeno-Collado

University Hospital Puerta de Hierro, Majadahonda.
Madrid, Madrid, Spain

Maria Rodriguez-Monsalve Herrero

Urologist
University Hospital Puerta de Hierro, Majadahonda.
Majadahonda, Madrid, Spain

Juan Martín de Pedro

Hospital Español de Buenos Aires
Buenos Aires, Buenos Aires, Argentina