Evaluation of PADUA Score as Predictor of Warm Ischemia Time (WIT) during Laparoscopic Partial Nephrectomy (LPN)

Abstract

Objective To evaluate the efficacy of Preoperative Aspects and Dimension Used for an Anatomical (PADUA) classification in the prediction of Warm Ischemia Time (WIT) during Laparoscopic Partial Nephrectomy (LPN). Methods Single centre retrospective study on 402 patients who underwent LPN between January 2011 and October 2013. WIT was correlated with each characteristics of the PADUA classification. Univariate and multivariate analysis were used to evaluated the independent predictive risk factors of WIT >20 minutes. Results The median WIT was 19.8 minutes (IQR 15-25). The PADUA risk groups (High vs Low: OR: 2.804; 95% CI 1.155-6.806; p-value <0.001; Intermediate vs Low: OR 0.971; 95% CI 0.185-5.092 p-value <0.001) and PADUA score as continuous variable (OR: 1.512; 95% CI 1.043-2.194; p-value <0.001) were the best independent risk factors of WIT >20 minutes. Another important factor related with WIT >20 minutes was a CKD stage 3 (p-value: 0.047; OR: 0.528; 95% CI:0.282-0.990). Conclusions This study reveal that tumor’ anatomical aspects may influence the WIT. The use of the nephrometry scoring systems should to be use by the surgeon in the planning of nephron sparing surgery (NSS) and should be considered for its inclusion in international guidelines.