RISK FACTORS FOR POSTOPERATIVE HEMORRHAGE AFTER PARTIAL NEPHRECTOMY

Karunamoorthy R, Harry santhaseelan, Venkata bhargava boppana

Abstract


Purpose

To evaluate the frequency and clinical characteristics of postoperative hemorrhage as a complication of partial nephrectomy.

Materials and Methods

The demographics, physical statistics, tumor size, R.E.N.A.L. nephrometry score, operative method, warm ischemic time, and presence of postoperative hemorrhage and its severity and method of intervention were examined in 300 partial nephrectomy patients in rajiv Gandhi government general hospital between March 2016 and March 2020.

Results

Of the 300 subjects, 13 (4.3%) experienced postoperative hemorrhage severe enough to require intervention more invasive than transfusion (Clavien grade III or higher). Univariate analysis of the bleeding and nonbleeding groups showed that whereas age, ischemic time, tumor size and stage, body mass index, American Society of Anesthesiologists class, and operative method did not differ significantly, the exophyticity (E) score was significantly higher for severe postoperative hemorrhage (p=0.04). However, multivariate analysis showed none of the factors to differ significantly. In most of the cases requiring intervention, selective embolization was sufficient, but in one case explorative laparotomy and nephrectomy were required. Clinical characteristics varied significantly among severe hemorrhage cases, with time of onset ranging from the first to the 30th postoperative day and symptoms presenting in a diverse manner, such as gross hematuria and pleuritic chest pain. Computed tomography and angiographic findings were consistent with either arteriovenous fistula or pseudoaneurysms.

Conclusions

Severe hemorrhage after partial nephrectomy is rare. Nonetheless, with the great variability in presenting symptoms and time of onset after surgery, surgeons should exercise great vigilance during the postoperative care of partial nephrectomy patients.

Keywords


Nephrectomy; Postoperative hemorrhage; Renal cell carcinoma.

Full Text:

PDF

References


Schrader AJ, Steffens S. renal cell carcinoma update: news from the AUA, EAU, and ASCO Annual Meetings 2011. ISRN Urol 2012;2012:748235.

Lifshitz DA, Shikanov SA, Deklaj T, Katz MH, Zorn KC, Shalhav AL. Laparoscopic partial nephrectomy for tumors larger than 4 cm: a comparative study. J Endourol 2010;24:49–55.

Zini L, Perrotte P, Capitanio U, Jeldres C, Shariat SF, Antebi E, et al. Radical versus partial nephrectomy: effect on overall and noncancer mortality. Cancer 2009;115:1465–1471.

Badalato GM, Kates M, Wisnivesky JP, Choudhury AR, McKiernan JM. Survival after partial and radical nephrectomy for the treatment of stage T1bN0M0 renal cell carcinoma (RCC) in the USA: a propensity scoring approach. BJU Int 2012;109:1457–1462.

Ghoneim TP, Thornton RH, Solomon SB, Adamy A, Favaretto RL, Russo P. Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy. J Urol 2011;185:2061–2065.

Montag S, Rais-Bahrami S, Seideman CA, Rastinehad AR, Vira MA, Kavoussi LR, et al. Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings. BJU Int 2011;107:1460–1466.

Novick AC, Campbell SC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, et al. Guidelines for management of the clinical stage I renal mass [Internet]. Linthicum(MD): American Urological Association Education and Research Inc.; c2009 [cited 2012 Nov 10].

Nadu A, Kleinmann N, Laufer M, Dotan Z, Winkler H, Ramon J. Laparoscopic partial nephrectomy for central tumors: analysis of perioperative outcomes and complications. J Urol 2009;181:42–47.

Ramani AP, Desai MM, Steinberg AP, Ng CS, Abreu SC, Kaouk JH, et al. Complications of laparoscopic partial nephrectomy in 200 cases. J Urol 2005;173:42–47.

Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 2007;178:41–46.

Van Poppel H, Bamelis B, Oyen R, Baert L. Partial nephrectomy for renal cell carcinoma can achieve long-term tumor control. J Urol 1998;160(3 Pt 1):674–678.

Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 2009;182:844–853.

Parsons RB, Canter D, Kutikov A, Uzzo RG. RENAL nephrometry scoring system: the radiologist's perspective. AJR Am J Roentgenol 2012;199:W355–W359.

Ficarra V, Novara G, Secco S, Macchi V, Porzionato A, De Caro R, et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 2009;56:786–793.

Simmons MN, Ching CB, Samplaski MK, Park CH, Gill IS. Kidney tumor location measurement using the C index method. J Urol 2010;183:1708–1713.

Bylund JR, Gayheart D, Fleming T, Venkatesh R, Preston DM, Strup SE, et al. Association of tumor size, location, R.E.N.A.L., PADUA and centrality index score with perioperative outcomes and postoperative renal function. J Urol 2012;188:1684–1689.

Mayer WA, Godoy G, Choi JM, Goh AC, Bian SX, Link RE. Higher RENAL Nephrometry Score is predictive of longer warm ischemia time and collecting system entry during laparoscopic and robotic-assisted partial nephrectomy. Urology 2012;79:1052–1056.

Hayn MH, Schwaab T, Underwood W, Kim HL. RENAL nephrometry score predicts surgical outcomes of laparoscopic partial nephrectomy. BJU Int 2011;108:876–881.

Liu ZW, Olweny EO, Yin G, Faddegon S, Tan YK, Han WK, et al. Prediction of perioperative outcomes following minimally invasive partial nephrectomy: role of the R.E.N.A.L. nephrometry score. World J Urol 2013;31:1183–1189.

DeVoe WB, Kercher KW, Hope WW, Lincourt AE, Norton HJ, Teigland CM. Hand-assisted laparoscopic partial nephrectomy after 60 cases: comparison with open partial nephrectomy. Surg Endosc 2009;23:1075–1080.

Lee S, Oh J, Hong SK, Lee SE, Byun SS. Open versus robot-assisted partial nephrectomy: effect on clinical outcome. J Endourol 2011;25:1181–1185.

Zorn KC, Starks CL, Gofrit ON, Orvieto MA, Shalhav AL. Embolization of renal-artery pseudoaneurysm after laparoscopic partial nephrectomy for angiomyolipoma: case report and literature review. J Endourol 2007;21:763–768.

Uberoi J, Badwan KH, Wang DS. Renal-artery pseudoaneurysm after laparoscopic partial nephrectomy. J Endourol 2007;21:330–333.


Refbacks

  • There are currently no refbacks.