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Is surgeon intuition equivalent to models of operative complexity in determining the surgical approach for nephron sparing surgery?
INTRODUCTION: The choice of approach for partial nephrectomy often depends on surgical complexity. We aimed to determine if surgeon intuition was equivalent to markers of operative complexity, such as RENAL nephrometry and Mayo adhesive probability (MAP) score, in determining the surgical approach f...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831501/ https://www.ncbi.nlm.nih.gov/pubmed/27127355 http://dx.doi.org/10.4103/0970-1591.179191 |
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author | Sharma, Pranav McCormick, Barrett Z. Zargar-Shoshtari, Kamran Sexton, Wade J. |
author_facet | Sharma, Pranav McCormick, Barrett Z. Zargar-Shoshtari, Kamran Sexton, Wade J. |
author_sort | Sharma, Pranav |
collection | PubMed |
description | INTRODUCTION: The choice of approach for partial nephrectomy often depends on surgical complexity. We aimed to determine if surgeon intuition was equivalent to markers of operative complexity, such as RENAL nephrometry and Mayo adhesive probability (MAP) score, in determining the surgical approach for partial nephrectomy (PN). MATERIALS AND METHODS: We retrospectively identified 119 masses removed for suspected renal cell carcinoma from January 2012 to September 2014 by a single surgeon who intuitively chose treatment with one of three surgical approaches: Open PN (OPN), robotic-assisted transperitoneal PN (RATPN), or robotic-assisted retroperitoneal PN (RARPN). Clinicodemographic characteristics, pathological features, and postoperative outcomes were compared for each approach. Logistic regression was performed to identify independent predictors of open surgical resection, our primary endpoint. RESULTS: Fifty-four tumors (45%) were resected via OPN, 40 (34%) via RATPN, and 25 (21%) via RARPN. OPN was performed in patients with more comorbidities (P = 0.02), lower baseline renal function (P < 0.01), more solitary kidneys (P < 0.01), and more multifocal disease (P < 0.01). Patients undergoing OPN had higher median nephrometry scores compared to RATPN and RARPN patients (8 vs. 7 vs. 7, respectively; P = 0.03), but MAP scores were no different among all three groups (P = 0.36). On multivariate analysis, higher nephrometry scores (odds ratio: 1.41, 95% confidence interval: 1.10-1.81; P = 0.007) were independently associated with open surgical resection. Nephrometry score was predictive of OPN (area under curve = 0.64, P = 0.01) with a score of 6.5 having the highest sensitivity and specificity (76% and 42%, respectively). CONCLUSIONS: RENAL nephrometry score was associated with surgical approach intuitively chosen by an experienced surgeon, but the presence of adherent perinephric fat did not correlate with decision-making. |
format | Online Article Text |
id | pubmed-4831501 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-48315012016-04-28 Is surgeon intuition equivalent to models of operative complexity in determining the surgical approach for nephron sparing surgery? Sharma, Pranav McCormick, Barrett Z. Zargar-Shoshtari, Kamran Sexton, Wade J. Indian J Urol Original Article INTRODUCTION: The choice of approach for partial nephrectomy often depends on surgical complexity. We aimed to determine if surgeon intuition was equivalent to markers of operative complexity, such as RENAL nephrometry and Mayo adhesive probability (MAP) score, in determining the surgical approach for partial nephrectomy (PN). MATERIALS AND METHODS: We retrospectively identified 119 masses removed for suspected renal cell carcinoma from January 2012 to September 2014 by a single surgeon who intuitively chose treatment with one of three surgical approaches: Open PN (OPN), robotic-assisted transperitoneal PN (RATPN), or robotic-assisted retroperitoneal PN (RARPN). Clinicodemographic characteristics, pathological features, and postoperative outcomes were compared for each approach. Logistic regression was performed to identify independent predictors of open surgical resection, our primary endpoint. RESULTS: Fifty-four tumors (45%) were resected via OPN, 40 (34%) via RATPN, and 25 (21%) via RARPN. OPN was performed in patients with more comorbidities (P = 0.02), lower baseline renal function (P < 0.01), more solitary kidneys (P < 0.01), and more multifocal disease (P < 0.01). Patients undergoing OPN had higher median nephrometry scores compared to RATPN and RARPN patients (8 vs. 7 vs. 7, respectively; P = 0.03), but MAP scores were no different among all three groups (P = 0.36). On multivariate analysis, higher nephrometry scores (odds ratio: 1.41, 95% confidence interval: 1.10-1.81; P = 0.007) were independently associated with open surgical resection. Nephrometry score was predictive of OPN (area under curve = 0.64, P = 0.01) with a score of 6.5 having the highest sensitivity and specificity (76% and 42%, respectively). CONCLUSIONS: RENAL nephrometry score was associated with surgical approach intuitively chosen by an experienced surgeon, but the presence of adherent perinephric fat did not correlate with decision-making. Medknow Publications & Media Pvt Ltd 2016 /pmc/articles/PMC4831501/ /pubmed/27127355 http://dx.doi.org/10.4103/0970-1591.179191 Text en Copyright: © Indian Journal of Urology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Sharma, Pranav McCormick, Barrett Z. Zargar-Shoshtari, Kamran Sexton, Wade J. Is surgeon intuition equivalent to models of operative complexity in determining the surgical approach for nephron sparing surgery? |
title | Is surgeon intuition equivalent to models of operative complexity in determining the surgical approach for nephron sparing surgery? |
title_full | Is surgeon intuition equivalent to models of operative complexity in determining the surgical approach for nephron sparing surgery? |
title_fullStr | Is surgeon intuition equivalent to models of operative complexity in determining the surgical approach for nephron sparing surgery? |
title_full_unstemmed | Is surgeon intuition equivalent to models of operative complexity in determining the surgical approach for nephron sparing surgery? |
title_short | Is surgeon intuition equivalent to models of operative complexity in determining the surgical approach for nephron sparing surgery? |
title_sort | is surgeon intuition equivalent to models of operative complexity in determining the surgical approach for nephron sparing surgery? |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831501/ https://www.ncbi.nlm.nih.gov/pubmed/27127355 http://dx.doi.org/10.4103/0970-1591.179191 |
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