Padua Score Accurately Predicts the Risk of Complication and Ischemic Time in Patients

PADUA score accurately predicts the risk of complication and ischemic time in patients who are candidates for nephron sparing surgery

Roscigno Marco1, Rayan Matloob2, Maria Nicolai1, Dehò Federico1, Deiana Gianfranco1, Petralia Giovanni2, Strada Elena2, Sozzi Francesco2, Bertini Roberto2, Da Pozzo Luigi Filippo1.

1 Dept. Of Urology, Ospedali Riuniti di Bergamo, Bergamo

2 Dept. Of Urology, Vita-Salute San Raffaele University, Milan.

Objectives: to prospectively test the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classification in a cohort of patients submitted to open nephron sparing surgery (NSS) and to correlate the PADUA score to ischemia time.

Methods: from December 2009 and September 2010, 112 consecutive patients were treated with open NSS with the technique of hilar arterial clamping. Tumor were reclassified according to the PADUA classification. Complication were graded according to the modified Clavien system. Univariable and multivariable logistic regression analyses tested the predictive value of PADUA score on overall complication rate and on the ischemic time.

Results: Sixty-one patients underwent extraperitoneal NSS through a flank incision, while 51 patients underwent transperitoneal approach. Mean patients age was 61.8 ± 13.3 years. The median tumor diameter was 3.4 ± 1.5 cm. The median PADUA score was 8 (range 6-13). Mean ischemia time was 20 ± 10 min. Overall complication rate was 18.7% (n = 21). On univariable analysis, the PADUA score correlated with complication rate(p = 0.027) and with increased ischemia time, considered as a continuous variable as well as categorical one (≤ 25 min vs 25 min) (p < 0.001 and p= 0.03, respectively). On multivariable analysis PADUA score achieved the independent predictor status of complication rate, after adjusting for body mass index and surgical approach. Patients with PADUA score 8-9 had a 4 –fold risk of complication, while patients with PADUA score ≥ 10 had a 15-fold risk compared to those with scores of 6-7 (p = 0.013). Moreover. patients with PADUA score ≥ 10 had a 6-fold risk of ischemic time > 25 minutes (p = 0.002).

Conclusions: our study confirms that PADUA score can reliably predict risk complication and ischemic time in patients treated with NSS, independently from the extra or transperitoneal approach. PADUA classification can help the selection of patients who may benefit from additional techniques such as hypothermic procedure.