Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Fragkiadis Evangelos
Dissertation committee:
Κωνσταντινίδης Κωνσταντίνος, Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Μητρόπουλος Διονύσιος, Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Αλαμανής Χρήστος, Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Νικητέας Νικόλαος, Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Στραβοδήμος Κωνσταντίνος, Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Αναστασίου Ιωάννης, Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Αδαμάκης Ιωάννης, Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Original Title:
H συννοσηρότητα ως προγνωστικό εργαλείο για την εκδήλωση μετεγχειρητικών επιπλοκών μετά από νεφρεκτομή
Translated title:
Comorbiditiy as a prognostic tool for the manifestation of postoperative complications after radical nephrectomy
Summary:
Introduction and Objectives
Comorbidity along with tumor and patient characteristics is taken into account when deciding for the surgical treatment of renal cell carcinoma (RCC). Comorbidity has also been used as an independent predictive factor for postoperative complications of several major urological procedures including radical nephrectomy for RCC. The aim of the present study was to objectively evaluate the association between comorbidity and postoperative complications after radical nephrectomy for RCC, by using standardized systems to grade both comorbidity and severity of postoperative complications.
Material and Methods
All patients that underwent scheduled radical Nephrectomy during the period 1/1/2010 – 30/9/2013 were included in our prospective study. Comorbidity was evaluated by the Charlson Comorbibidity Index (CCI) and Age Adjusted Charlson Comorbidity Index (AA-CCS). Postoperative complications were monitored for 40 postoperative days and graded according to the Clavien-Dindo system.
Results
171 patients were included in our study (11 patients excluded due to insufficient data) aged 35-88 years (mean. 6.,6±11.7 years).
CCI was 0 for 87 patients, 1 for 38 patients, 2 for 21 patients, 3 for 8 patients, 4 for 4 patients, 5 for one patient, 6 for 8 patients, 7 for 2 patients and 8 for 2 patients.
Ο AA-CCI was 0 for 19 patients, 1 for 26 patients, 2 for 31 patients, 3 for 40 patients, 4 for 18 patients, 5 for 15 patients, 6 for 3 patients, 7 for 8 patients, 8 for 8 patients, 9 for one patient και 10 for 2 patients.
98 patients (57.3%) suffered no complications. Of the 73 patients that suffered a complication, the grade according to Clavien Dindo was: 1 for 35 patients, 2 for 24 patients, 3 for 4 patients, 4 for 6 patients και 5 for 4 patients
Data analysis reveal statistical significant correlation of CCI and AA-CCI with Clavien (p=0.038 and p=0.014 respectively) and positive prognostic ability for patients in danger of suffering a serious (Clavien >2) (ROC curve area 0.794 και 0.753 respectively) p<0.05.
Conclusions
The present prospective study showed that significantly more major complications occur in patients with major comorbidities. CCI and AA-CCI are easily calculated and should be incorporated in preoperative consultation especially in cases of elder patients with severe comorbidity and favorable tumor characteristics where less invasive interventions or even active surveillance could be applied.
Main subject category:
Health Sciences
Keywords:
Comorbidities, Renal cancer, Kidney cancer, Preoperative evaluation, Postoperative complcations, Clavien dindo, Charlson comorbidity index, Clinical prognostic factors
Number of references:
144
