Multi-center analysis on pre-operative predictors of Margin, Ischemia and Complications (MIC) after laparoscopic partial nephrectomy (LPN)

==inizio abstract==

In 2012 Buffi et al proposed a new score system to evaluate success in PN, the Margin, Ischemia and Complications (MIC). According to this newly proposed scoring system, an optimal partial nephrectomy (PN) is accomplished when surgical margins (SM) are negative, warm ischemia time (WIT) was ≤20 minutes and no major complications (Clavien-Dindo grade 3-4) were observed. Aim of this study is to evaluate pre-operative factors that may potentially influence this scoring system.This is a retrospective multi-centers study on LPN performed beetween January 2012 and September 2014. Spearman Rank Order Correlation (Rho) was used to evaluate the relationship between clinical patients characteristics with MIC score.The relationship was defined as small (rho= 0.10 to 0.29), medium (rho= 0.30 to 0.49) and large (rho= 0.50 to 1).A binary regression analysis was done in order to evaluate pre-operative independent factors related with MIC success.A total of 316 patients were enrolled in this study.We found in Spearman correlation that median tumor size (rho: -0.170 p-value: 0.002), median PADUA score (rho: -0.179; p-value: <0.001), PADUA risk groups (rho: -0.191; p-value: <0.001), renal rim (rho: -0.113; p-value: 0.044), renal sinus (rho: -0.154; p-value: 0.006), urinary collecting system (UCS) (rho: -0.170; p-value: 0.002) and tumor size coded as categorical variable (rho: -0.152; p-value: 0.007) were inversely related with MIC score system. Low point assigned to each PADUA anatomical features presented high probability of MIC success. In the binary logistic regression, clinical tumor size (p-value: <0.001; OR: 0.829; 95% CI: 0.697-0.987), PADUA score(continuosly coded) (p-value: <0.001; OR: 0.843; 95% CI:0.740-0.960) and PADUA risk groups (low: reference; intermediate: p-value: <0.001; OR: 0.416; 95% CI: 0.238-0.792; high: p-value: <0.001; OR: 0.356; 95% CI: 0.199-0.636) were independently related with MIC success.The MIC score is influenced by several anatomical aspects and the use of nephrometry score is useful to predict MIC success. ==fine abstract==