What Is Better for Predicting Morbidity of Robotic Partial Nephrectomy—A Score or Your Clinical Judgement?

• DOI: 10.1016/j.euf.2018.10.016
• Publication Date: 2018-11-13T01:13:57Z
• Authors: Zine‐Eddine Khene; Benoit Peyronnet; Lucas Freton; Vivien Graffeille; Benjamin Pradere; Corentin Robert; Solène-Florence K...; Grégory Verhoest; Nathalie Rioux-Le...; Shahrokh Shariat; Romain Mathieu; Karim Bensalah
• Keywords: Male; [SDV]Life Sciences [q-bio]; Urology; Reproducibility of Results; Middle Aged; Clinical Reasoning; Prognosis; Nephrectomy; 3. Good health; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Robotic Surgical Procedures; Humans; Female; Prospective Studies; Morbidity; Aged

Little is known about the predictive value of surgeon's judgement to estimate perioperative outcomes following robotic partial nephrectomy (RPN).To evaluate the accuracy of surgeon's intuition to estimate perioperative outcomes of patients undergoing RPN and compare its predictive value with that of objective scoring systems.We prospectively analysed 100 consecutive patients who underwent RPN.RENAL, PADUA, and MAP scores were calculated based on preoperative imaging. The surgeon gave a subjective estimation of the technical difficulty and the risk of postoperative complications of RPN immediately before and after surgery using a visual analogue scale (VAS). Correlation between scores, VAS, estimated blood loss (EBL), operative time (OT), and warm ischaemia time (WIT) were examined. Logistic regression analyses were performed to identify the best predictors of overall complications. Receiver operating characteristic (ROC) curve analysis was used to assess the accuracy of VAS and scoring systems to predict trifecta achievement.RENAL, PADUA, and MAP scores significantly correlated with surgeon's pre- and postoperative VAS evaluation, with the RENAL score showing the strongest correlation (r=0.49 and r=0.34, respectively). Pre- and postoperative VAS scores had the strongest correlation with EBL (r=0.48 and r=0.59, respectively), OT (r=0.44 and r=0.65, respectively), and WIT (r=0.37 and r=0.47, respectively). In multivariate analysis adjusted for anticoagulant/antiplatelet treatment, body mass index, surgeon's experience, and Charlson comorbidity index, only surgeon's prediction could significantly predict overall complications (odds ratio=5.42, p <0.001). Finally, surgeon's intuition was better to predict trifecta accomplishment than all radiological scores (ROC areas under the curves were 0.76 and 0.77 for pre- and postoperative VAS scores, respectively).Surgeon's clinical assessment is a good predictor of perioperative outcomes of RPN and seems to perform better than conventional scores.In this report, we found that surgeon's clinical feeling can better predict perioperative morbidity of robotic partial nephrectomy than conventional radiological scores.