Factors associated with prolonged length of stay following robotic-assisted partial nephrectomy.

INTRODUCTION: To prospectively analyze the association of clinical and operative variables on patient length of hospital stay (LOS) following robotic-assisted partial nephrectomy (RAPN) and develop an accurate clinical-based scoring system to predict prolonged LOS following RAPN. MATERIALS AND METHODS: We analyzed 304 consecutive RAPNs performed by a single surgeon. Prolonged LOS was defined as greater than 3 days of hospitalization postoperatively. Preoperative clinical factors and operative variables were analyzed for association with LOS. After adjusting for multiple testing, p ≤ 0.004 was considered statistically significant. RESULTS: LOS was 1 day in 17 (5.6%) patients, 2 days in 136 (44.7%) patients, 3 days in 89 (29.3%) patients, and more than 3 days in 62 (20.4%) patients. Lower preoperative hemoglobin (p = 0.004), total operative time (p < 0.001), estimated blood loss (EBL) (p < 0.001), intraoperative complications or conversion (p < 0.001), and renal mass size (p < 0.001) were associated with prolonged LOS. EBL and total operative time were most predictive of prolonged LOS and were used to create the BLOT (blood loss and operative time) predictive scoring system. Blot scores ranged from 0 to 5, to predict prolonged LOS. We observed prolonged LOS in 4.3%, 9.6%, 25.6%, 47.1%, 50.0%, and 100% of patients with scores of 0, 1, 2, 3, 4, and 5, respectively. CONCLUSIONS: Operative time and estimated blood loss are most predictive of prolonged LOS following RAPN. Using these variables, the BLOT score accurately predicts prolonged LOS following RAPN.

The Association of the Mayo Adhesive Probability (MAP) Score With Total Operative Time in Patients Undergoing Hand-assisted Laparoscopic Donor Nephrectomy.

OBJECTIVE: To assess whether donor kidney Mayo Adhesive probability (MAP) score is associated with (total operative time) ORT in patients undergoing hand-assisted laparoscopic donor nephrectomy (HALDN). METHODS: Three hundred and thirty-one patients undergoing HALDN were reviewed. Donor kidney MAP scores were recorded based on preoperative computed tomography or magnetic resonance imaging. Single variable and multiple variable regression analysis were used to evaluate the correlation between MAP score and ORT. RESULTS: Three hundred and thirty-one patients underwent HALDN between January 2007 and April 2017. Median body mass index was 26.4 kg/m2 (interquartile range 23.4, 29.5) and median age at time of surgery was 45 years (interquartile range 37, 53). Two hundred and thirty-one patients had donor kidney MAP = 0. Hundred patients had donor kidney MAP >0. Mean ORT was 163 minutes for females with MAP = 0 and 166 minutes for females with MAP >0. Median ORT was 180 minutes for males with MAP =0 and 191 minutes for males with MAP >0. Donor kidney MAP score > 0 was significantly correlated with longer ORT (increase of 24.4 minutes, P = .001) in single variable analysis. In multivariable analysis, this correlation was only significant for males (increase of 28.9 minutes, P = .013). CONCLUSION: MAP score > 0 is associated with longer ORT for males undergoing HALDN.

Alcohol consumption, variability in alcohol dehydrogenase genes and risk of renal cell carcinoma.

Alcohol consumption has been associated inversely with renal cell carcinoma (RCC) risk; however, no study has examined effect modification by germline variation in alcohol-metabolizing genes. We investigated whether the association between alcohol intake and RCC risk is modulated by germline variants in alcohol dehydrogenase genes in a large case-control study. Data from 652 RCC cases and 1,366 non-cancer controls were analyzed. Alcohol intake was assessed using a standardized risk factor questionnaire. Three previously genotyped polymorphisms in ADH6 and ADH7 with the TaqMan assay were examined. Odds ratios (ORs) and 95% confidence interval (CI) were calculated using logistic regression, adjusting for covariates. Compared to non-drinkers, ever consumption of alcohol was associated with lower RCC risk (OR = 0.52, 95% CI = 0.42-0.65). Analysis with cubic spline regression curve showed a "J-shaped" relationship between alcohol drinks/day and RCC risk, such that there was no added benefit against RCC for consumption of more than two drinks/day. We observed effect modification by variation in rs1154454 (ADH7) (pinteraction = 0.007); a per unit increase in alcohol drink/day was associated with 35% lower RCC risk among non-minor allele carriers, a 27% lower risk among those who carry one copy of the minor allele, but no association was observed among those with two copies of the minor allele. These findings indicate that alcohol consumption is associated with lower RCC risk. Consuming more than two drinks a day does not confer additional protection against RCC. The association between alcohol intake and RCC risk appears to be modulated by inter-individual germline variation in alcohol-metabolizing genes.

Coffee consumption and risk of renal cell carcinoma.

BACKGROUND: Studies have suggested an inverse association between coffee consumption and risk of renal cell carcinoma (RCC); however, data regarding decaffeinated coffee are limited. METHODS: We conducted a case-control study of 669 incident RCC cases and 1,001 frequency-matched controls. Participants completed identical risk factor questionnaires that solicited information about usual coffee consumption habits. The study participants were categorized as non-coffee, caffeinated coffee, decaffeinated coffee, or both caffeinated and decaffeinated coffee drinkers. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression, adjusting for multiple risk factors for RCC. RESULTS: Compared with no coffee consumption, we found an inverse association between caffeinated coffee consumption and RCC risk (OR 0.74; 95% CI 0.57-0.99), whereas we observed a trend toward increased risk of RCC for consumption of decaffeinated coffee (OR 1.47; 95% CI 0.98-2.19). Decaffeinated coffee consumption was associated also with increased risk of the clear cell RCC (ccRCC) subtype, particularly the aggressive form of ccRCC (OR 1.80; 95% CI 1.01-3.22). CONCLUSIONS: Consumption of caffeinated coffee is associated with reduced risk of RCC, while decaffeinated coffee consumption is associated with an increase in risk of aggressive ccRCC. Further inquiry is warranted in large prospective studies and should include assessment of dose-response associations.

Mayo Adhesive Probability Score Is Associated With Localized Renal Cell Carcinoma Progression-free Survival.

OBJECTIVE: To assess the association of the Mayo Adhesive Probability (MAP) score and progression-free survival (PFS) in patients with renal cell carcinoma (RCC). The MAP score is derived from cross-sectional imaging measurements of perinephric fat thickness and stranding. MATERIALS AND METHODS: We identified 456 patients from a prospective registry who were treated surgically for localized RCC between 2002 and 2014. One reviewer calculated a preoperative MAP score (0-5) for each patient. Kaplan-Meier curves were utilized to estimate PFS. Cox proportional hazard models were used to estimate the association of MAP score with risk of progression univariately and after adjusting for covariates such as age, body mass index (BMI), and size, stage, grade, necrosis scores. RESULTS: Patients with higher MAP scores (4-5) were more likely to be male, to be older, to have higher BMI, and to have larger tumors (all P <.01). Of our total cohort, 405 patients had MAP scores and follow-up data to assess PFS. Dichotomizing MAP scores into high (MAP 4-5) and low (MAP 0-3) yields a hazard ratio of 2.16 for the 4-5 group vs 0-3 (95% confidence interval: 1.15-4.06, P = .017). Adjustment for BMI did not alter the association (BMI-adjusted hazard ratio [HR] = 2.20 [1.07-4.52], P = .032). Of interest, the association with MAP and PFS remains for pT1 RCC patients (n = 287, HR = 3.46 [1.06-11.24], P = .039). CONCLUSION: High MAP scores (4-5) are associated with decreased PFS in patients surgically treated for clinically localized RCC compared with patients with lower MAP scores (0-3). RCC aggressiveness may be associated with perinephric fat thickness and stranding.

Comparison of patient-reported quality of life outcome questionnaire response rates between patients treated surgically for renal cell carcinoma and prostate carcinoma.

BACKGROUND: We sought to examine differences in response rates to quality of life (QoL) surveys in patients treated surgically for renal cell carcinoma (RCC) and prostate cancer (PCa) and to analyze factors associated with non-response of the surveys. METHODS: Patients who underwent surgery for RCC or PCa between 2006 and 2012 were offered enrollment in respective prospective cancer registries that included baseline and annual QoL assessments. We identified 201 RCC patients and 616 PCa patients who completed a baseline QoL survey and were mailed annual QoL surveys [RCC: SF-36, FACT-G (73 questions), PCa: EPIC, IIEF, Max-PC (80 questions)]. We compared patient characteristics between responders and non-responders using a Wilcoxon rank-sum test for continuous variables and a Fisher's Exact test for categorical variables. RESULTS: The overall response rates for the PCa and RCC groups were 63 and 48% (p < 0.001), respectively. This difference in response rates remained when we limited analysis to only those with early stage disease (pT2 for PCa and pT1 RCC, 62% vs. 52%; p = 0.03). PCa characteristics associated with response included older age (64.1 vs 62.6 years, p = 0.032) and robotic versus open surgery (56% vs 44%; p = 0.009). There were no characteristics that were associated with response in RCC patients. CONCLUSIONS: Surgically treated PCa patients have higher QoL mail-based survey response rates compared to patients treated surgically for RCC. This difference holds true for clinically localized cancers as well.

Prospective evaluation of the association of adherent perinephric fat with perioperative outcomes of robotic-assisted partial nephrectomy.

OBJECTIVE: To prospectively analyze the association of adherent perinephric fat (APF) with perioperative outcomes of robotic-assisted partial nephrectomy (RAPN). METHODS: We analyzed 100 consecutive RAPNs performed by a single experienced surgeon and defined APF as the necessity of subcapsular renal dissection to mobilize the kidney and isolate the renal tumor for RAPN. Our primary analysis focused on comparing perioperative outcomes, including operative time, warm ischemia time, estimated blood loss, postoperative complications, length of stay, and margins, ischemia, and complications score between patients with and without APF. To control the probability of obtaining a false-positive finding at 5% after the numerous statistical comparisons that were performed, we used a Bonferroni correction for multiple comparisons, after which P values of ≤.0042 were considered to be statistically significant. RESULTS: Thirty patients (30%) had APF. Presence of APF was not significantly associated with blood loss, warm ischemia time, hospital stay, postoperative complications, or margins, ischemia, and complications score. We noted some evidence of longer operative times in patients with APF compared with those without APF (median, 223 vs199 minutes; P = .026); however, this was not significant after adjustment for multiple comparisons. In multivariate analysis, we noted stronger evidence of associations with increased operative time for RENAL score (P <.001) and body mass index (P = .020) than for the presence of APF (P = .32). CONCLUSION: APF may be associated with slightly longer operative times but does not appear to affect perioperative complications or outcomes.

Mayo adhesive probability score: an accurate image-based scoring system to predict adherent perinephric fat in partial nephrectomy.

BACKGROUND: Image-based renal morphometry scoring systems are used to predict the potential difficulty of partial nephrectomy (PN), but they are centered entirely on tumor-specific factors and neglect other patient-specific factors that may complicate the technical aspects of PN. Adherent perinephric fat (APF) is one such factor known to make PN difficult. OBJECTIVE: To develop an accurate image-based nephrometry scoring system to predict the presence of APF encountered during robot-assisted partial nephrectomy (RAPN). DESIGN, SETTING, AND PARTICIPANTS: We prospectively analyzed 100 consecutive RAPNs performed by one surgeon and defined APF as the need for subcapsular renal dissection to isolate the renal tumor for RAPN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The scoring algorithm to predict the presence of APF was developed with a multivariable logistic regression model using a forward selection approach with a focus on improvement in the area under the receiver operating characteristic curve. RESULTS AND LIMITATIONS: Thirty patients (30%; 95% confidence interval, 21-40) had APF. Single-variable analysis noted an increased likelihood of APF in male patients (p<0.001), higher body mass index (p=0.003), greater posterior perinephric fat thickness (p<0.001), greater lateral perinephric fat thickness (p<0.001), and those with perirenal fat stranding (p<0.001). Two of these variables, posterior perinephric fat thickness and stranding, were most highly predictive of APF in multivariable analysis and were therefore used to create a risk score, termed Mayo Adhesive Probability (MAP) and ranging from 0 to 5, to predict the presence of APF. We observed APF in 6% of patients with a MAP score of 0, 16% with a score of 1, 31% with a score of 2, 73% with a score of 3-4, and 100% of patients with a score of 5. CONCLUSIONS: MAP score accurately predicts the presence of APF in patients undergoing RAPN. Prospective validation of the MAP score is required. PATIENT SUMMARY: The Mayo Adhesive Probability score that we we developed is an accurate system that predicts whether or not adherent perinephric, or "sticky," fat is present around the kidney that would make partial nephrectomy difficult.