Performing an early systematic Doppler-ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomy.
Doppler-ultrasound
kidney cancer
oncology
partial nephrectomy
Journal
Therapeutic advances in urology
ISSN: 1756-2872
Titre abrégé: Ther Adv Urol
Pays: England
ID NLM: 101487328
Informations de publication
Date de publication:
Historique:
received:
03
10
2018
accepted:
23
12
2018
entrez:
26
2
2019
pubmed:
26
2
2019
medline:
26
2
2019
Statut:
epublish
Résumé
The aim of this work was to assess the clinical relevance of a systematic postoperative Doppler-ultrasound (DU) after complex partial nephrectomy (PN). All patients who underwent open, laparoscopic or robotic PN from 2014 to 2017 at our institution were included. Postoperative hemorrhagic complications (HCs) were defined as the occurrence of blood transfusion, hemorrhagic shock, arterial embolization, or re-hospitalization for hematoma. DU was systematically performed between post-op day 4 and 7 for every complex tumor (RENAL score ⩾ 7). DU was considered positive in the presence of pseudoaneurysm (PA) or arteriovenous fistula (AVF). Among 194 patients, 117 underwent DU (60.3%). We reported 22 HCs (11.3%) requiring 8 selective embolization procedures (4.1%). HCs occurred during the hospital stay in 17 patients (77.3%), thus directly diagnosed on a computed tomography scan. Among the five patients (22.7%) with HC occurring after hospital discharge, between day 7 to 15, four had a previously negative systematic DU. Overall, systematic DU was positive in only five patients (4.3%) with only one patient of 194 (0.5%) undergoing preventive embolization of a PA-AVF. The negative predictive values (NPVs) and positive predictive values of DU were respectively 96.5% and 5%, with 20% sensitivity and 96.5% specificity. Our results may suggest offering systematic DU in patients under antiplatelet therapies, with high tumor size (>T1b), or early postoperative hemoglobin variations. A high NPV of DU might be counterbalanced by its low sensibility. Since all secondary HCs occurred between postoperative day 7 to 15, our results may suggest differing DU in selected cases.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of this work was to assess the clinical relevance of a systematic postoperative Doppler-ultrasound (DU) after complex partial nephrectomy (PN).
MATERIALS AND METHODS
METHODS
All patients who underwent open, laparoscopic or robotic PN from 2014 to 2017 at our institution were included. Postoperative hemorrhagic complications (HCs) were defined as the occurrence of blood transfusion, hemorrhagic shock, arterial embolization, or re-hospitalization for hematoma. DU was systematically performed between post-op day 4 and 7 for every complex tumor (RENAL score ⩾ 7). DU was considered positive in the presence of pseudoaneurysm (PA) or arteriovenous fistula (AVF).
RESULTS
RESULTS
Among 194 patients, 117 underwent DU (60.3%). We reported 22 HCs (11.3%) requiring 8 selective embolization procedures (4.1%). HCs occurred during the hospital stay in 17 patients (77.3%), thus directly diagnosed on a computed tomography scan. Among the five patients (22.7%) with HC occurring after hospital discharge, between day 7 to 15, four had a previously negative systematic DU. Overall, systematic DU was positive in only five patients (4.3%) with only one patient of 194 (0.5%) undergoing preventive embolization of a PA-AVF. The negative predictive values (NPVs) and positive predictive values of DU were respectively 96.5% and 5%, with 20% sensitivity and 96.5% specificity.
CONCLUSIONS
CONCLUSIONS
Our results may suggest offering systematic DU in patients under antiplatelet therapies, with high tumor size (>T1b), or early postoperative hemoglobin variations. A high NPV of DU might be counterbalanced by its low sensibility. Since all secondary HCs occurred between postoperative day 7 to 15, our results may suggest differing DU in selected cases.
Identifiants
pubmed: 30800173
doi: 10.1177/1756287219828966
pii: 10.1177_1756287219828966
pmc: PMC6378436
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1756287219828966Déclaration de conflit d'intérêts
Conflict of interest statement: The authors declare that there is no conflict of interest.
Références
Urology. 2003 Aug;62(2):227-31
pubmed: 12893324
J Urol. 2005 Jan;173(1):42-7
pubmed: 15592022
J Urol. 2005 Dec;174(6):2256-9
pubmed: 16280793
J Urol. 2007 Jul;178(1):41-6
pubmed: 17574056
Clin Radiol. 2007 Nov;62(11):1104-9
pubmed: 17920871
Arch Intern Med. 2009 Dec 14;169(22):2078-86
pubmed: 20008690
World J Urol. 2010 Aug;28(4):519-24
pubmed: 20563584
BJU Int. 2011 May;107(9):1460-6
pubmed: 20831568
Radiology. 2010 Oct;257(1):24-39
pubmed: 20851938
Urology. 2011 Oct;78(4):820-6
pubmed: 21813164
Eur Urol. 2012 May;61(5):972-93
pubmed: 22405593
J Urol. 2012 Jun;187(6):2000-4
pubmed: 22498208
Urology. 2013 Feb;81(2):301-6
pubmed: 23374787
Eur Urol. 2015 May;67(5):891-901
pubmed: 25572825
Int J Urol. 2015 Apr;22(4):356-61
pubmed: 25581594
J Vasc Interv Radiol. 2015 Jul;26(7):950-7
pubmed: 25881511
Int J Urol. 2015 Dec;22(12):1096-102
pubmed: 26307333
Rofo. 2016 Feb;188(2):188-94
pubmed: 26756934
Acta Radiol Open. 2016 Aug 10;5(8):2058460116655833
pubmed: 27570638
Cardiovasc Intervent Radiol. 2017 Feb;40(2):202-209
pubmed: 27681271