1850 PROGNOSTIC SIGNIFICANCE OF MODIFIED GLASGOW PROGNOSTIC SCORE AS A PREDICTOR OF TUMOR PROGRESSION IN PATIENTS TREATED FOR LOCALIZED RENAL CELL CARCINOMA

We sought to define the incidence of overall and severe complications after partial nephrectomy based on the EASGS, and identify the preoperative and operative risk factors for the development of complications. METHODS: A prospectively maintained retrospective database of all nephrectomies at our institution identified 251 partial nephrectomy procedures performed by any approach from 2000 to 2011. Severity of complications was graded using EASGS, which ranges on a scale from 1-6. Univariable and multivariable analyses were performed using all pre-operative and operative variables for likelihood of post-operative overall morbidity (Grades 1-6) or severe morbidity (Grades 3-6). RESULTS: Of the complications, 52.5% were grade 1, 22.1% were grade 2, 15.6% were grade 3, 8.2% were grade 4, 0.4% were grade 5, and 0.4% were grade 6. On multivariable analysis, R.E.N.A.L nephrometry score (OR 1.742, 95% CI 1.32-2.28 for overall, OR 2.185 95% CI 1.51-3.15 for severe) and multiple renal arteries (OR 2.822, 95% CI 1.09-7.24 for overall, OR 4.191, 95% CI 1.54-12.54 for severe) were significant predictors of both overall and severe morbidities. Higher BMI (OR 1.057, 95% CI 1.001-1.117) predicted higher overall morbidity, while presence of a solitary kidney was a significant predictor of severe morbidity (OR 7.097, 95% CI 1.32-37.94). More recent year of surgery (OR 0.304, 95% CI 0.119-0.777) predicted for decreased overall complications. Age, sex, race, multiple tumors, smoking status, side, surgical approach, BMI, ASA score, tumor size, blood loss, operative time, preoperative serum creatinine, warm ischemia time, prior abdominal surgery, and collecting system entry did not predict for overall or severe complications. CONCLUSIONS: When subjected to the more stringent EASGS, various factors predict for both overall and severe complications. These data can help stratify patients preoperatively when counseling them about the attendant risks of partial nephrectomy.