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Kallidonis P, Spinos T, Zondervan P, Nyirády P, Backhaus MR, Micali S, Hruby S, Alvarez-Maestro M, Tatanis V, Liatsikos E, Gözen AS. Predictive Value of the Mayo Adhesive Probability (MAP) Score in Laparoscopic Partial Nephrectomies: A Systematic Review from the EAU Section of Uro-Technology (ESUT). Cancers (Basel) 2024; 16:1455. [PMID: 38672537 PMCID: PMC11048046 DOI: 10.3390/cancers16081455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
The Mayo Adhesive Probability (MAP) score is a radiographic scoring system that predicts the presence of adherent perinephric fat (APF) during partial nephrectomies (PNs). The purpose of this systematic review is to summarize the current literature on the application of the MAP score for predicting intraoperative difficulties related to APF and complications in laparoscopic PNs. Three databases, PubMed, Scopus and Cochrane, were screened, from inception to 29 October 2023, taking into consideration the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. All the inclusion criteria were met by eight studies. The total operative time was around two hours in most studies, while the warm ischemia time was <30 min in all studies and <20 min in four studies. Positive surgical margins, conversion and transfusion rates ranged from 0% to 6.3%, from 0% to 5.0% and from 0.7% to 7.5%, respectively. Finally, the majority of the complications were classified as Grade I-II, according to the Clavien-Dindo Classification System. The MAP score is a useful tool for predicting not only the presence of APF during laparoscopic PNs but also various intraoperative and postoperative characteristics. It was found to be significantly associated with an increased operative time, estimated blood loss and intraoperative and postoperative complication rates.
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Affiliation(s)
- Panagiotis Kallidonis
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (T.S.); (V.T.); (E.L.)
- Laparoscopy Working Group, European Association of Urology (EAU) Section of Uro-Technology; (P.Z.); (P.N.); (M.R.B.); (S.M.); (S.H.); (M.A.-M.); (A.S.G.)
| | - Theodoros Spinos
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (T.S.); (V.T.); (E.L.)
| | - Patricia Zondervan
- Laparoscopy Working Group, European Association of Urology (EAU) Section of Uro-Technology; (P.Z.); (P.N.); (M.R.B.); (S.M.); (S.H.); (M.A.-M.); (A.S.G.)
- Department of Urology, Amsterdam Medical Centers, 1081 Amsterdam, The Netherlands
| | - Peter Nyirády
- Laparoscopy Working Group, European Association of Urology (EAU) Section of Uro-Technology; (P.Z.); (P.N.); (M.R.B.); (S.M.); (S.H.); (M.A.-M.); (A.S.G.)
- Department of Urology, Semmelweis University Budapest, 1083 Budapest, Hungary
| | - Miguel Ramírez Backhaus
- Laparoscopy Working Group, European Association of Urology (EAU) Section of Uro-Technology; (P.Z.); (P.N.); (M.R.B.); (S.M.); (S.H.); (M.A.-M.); (A.S.G.)
- Department of Urology, Fundación Instituto Valenciano de Oncología, 46009 Valencia, Spain
| | - Salvatore Micali
- Laparoscopy Working Group, European Association of Urology (EAU) Section of Uro-Technology; (P.Z.); (P.N.); (M.R.B.); (S.M.); (S.H.); (M.A.-M.); (A.S.G.)
- Department of Urology, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Stephan Hruby
- Laparoscopy Working Group, European Association of Urology (EAU) Section of Uro-Technology; (P.Z.); (P.N.); (M.R.B.); (S.M.); (S.H.); (M.A.-M.); (A.S.G.)
- Department of Urology, Tauernklinikum Paracelsusstrasse 8, Zell/See, 5700 Salzburg, Austria
| | - Mario Alvarez-Maestro
- Laparoscopy Working Group, European Association of Urology (EAU) Section of Uro-Technology; (P.Z.); (P.N.); (M.R.B.); (S.M.); (S.H.); (M.A.-M.); (A.S.G.)
- Department of Urology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Vasileios Tatanis
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (T.S.); (V.T.); (E.L.)
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Hospital, 26504 Patras, Greece; (T.S.); (V.T.); (E.L.)
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
| | - Ali Serdar Gözen
- Laparoscopy Working Group, European Association of Urology (EAU) Section of Uro-Technology; (P.Z.); (P.N.); (M.R.B.); (S.M.); (S.H.); (M.A.-M.); (A.S.G.)
- Department of Urology, Medius-Kliniken Ruit, University of Tubingen, 73760 Ostfildern, Germany
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Goldenberg MG, Cacciamani GE. Re: Gopal Sharma, Milap Shah, Puneet Ahluwalia, et al. Development and Validation of a Nomogram Predicting Intraoperative Adverse Events During Robot-assisted Partial Nephrectomy. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2022.09.004. Eur Urol Focus 2022:S2405-4569(22)00274-7. [DOI: 10.1016/j.euf.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
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Sharma G, Shah M, Ahluwalia P, Dasgupta P, Challacombe BJ, Bhandari M, Ahlawat R, Rawal S, Buffi NM, Sivaraman A, Porter JR, Rogers C, Mottrie A, Abaza R, Rha KH, Moon D, Yuvaraja TB, Parekh DJ, Capitanio U, Maes KK, Porpiglia F, Turkeri L, Gautam G. Development and Validation of a Nomogram Predicting Intraoperative Adverse Events During Robot-assisted Partial Nephrectomy. Eur Urol Focus 2022; 9:345-351. [PMID: 36153228 DOI: 10.1016/j.euf.2022.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/27/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ability to predict the risk of intraoperative adverse events (IOAEs) for patients undergoing partial nephrectomy (PN) can be of great clinical significance. OBJECTIVE To develop and internally validate a preoperative nomogram predicting IOAEs for robot-assisted PN (RAPN). DESIGN, SETTING, AND PARTICIPANTS In this observational study, data for demographic, preoperative, and postoperative variables for patients who underwent RAPN were extracted from the Vattikuti Collective Quality Initiative (VCQI) database. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS IOAEs were defined as the occurrence of intraoperative surgical complications, blood transfusion, or conversion to open surgery/radical nephrectomy. Backward stepwise logistic regression analysis was used to identify predictors of IOAEs. The nomogram was validated using bootstrapping, the area under the receiver operating characteristic curve (AUC), and the goodness of fit. Decision curve analysis (DCA) was used to determine the clinical utility of the model. RESULTS AND LIMITATIONS Among the 2114 patients in the study cohort, IOAEs were noted in 158 (7.5%). Multivariable analysis identified five variables as independent predictors of IOAEs: RENAL nephrometry score (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.02-1.25); clinical tumor size (OR 1.01, 95% CI 1.001-1.024); PN indication as absolute versus elective (OR 3.9, 95% CI 2.6-5.7) and relative versus elective (OR 4.2, 95% CI 2.2-8); Charlson comorbidity index (OR 1.17, 95% CI 1.05-1.30); and multifocal tumors (OR 8.8, 95% CI 5.4-14.1). A nomogram was developed using these five variables. The model was internally valid on bootstrapping and goodness of fit. The AUC estimated was 0.76 (95% CI 0.72-0.80). DCA revealed that the model was clinically useful at threshold probabilities >5%. Limitations include the lack of external validation and selection bias. CONCLUSIONS We developed and internally validated a nomogram predicting IOAEs during RAPN. PATIENT SUMMARY We developed a preoperative model than can predict complications that might occur during robotic surgery for partial removal of a kidney. Tests showed that our model is fairly accurate and it could be useful in identifying patients with kidney cancer for whom this type of surgery is suitable.
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Affiliation(s)
- Gopal Sharma
- Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Milap Shah
- Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Puneet Ahluwalia
- Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Prokar Dasgupta
- Faculty of Life Sciences and Medicine, King's Health Partners, King's College, London, UK
| | | | | | | | - Sudhir Rawal
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | | | | | | | | | | | - Ronney Abaza
- Central Ohio Urology Group and Mount Carmel Health System Prostate Cancer Program, Columbus, OH, USA
| | - Khoon Ho Rha
- Yonsei University Health System, Seoul, South Korea
| | - Daniel Moon
- Peter MacCallum Cancer Centre, Royal Melbourne Clinical School, University of Melbourne, Melbourne, Australia
| | | | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Kris K Maes
- Center for Robotic and Minimally Invasive Surgery, Hospital Da Luz, Lisbon, Portugal
| | | | - Levent Turkeri
- Department of Urology, Acıbadem M.A, Aydınlar University, Altuzinade Hospital, Istanbul, Turkey
| | - Gagan Gautam
- Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India.
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Jin D, Tan X, Hu J, Zhang W, Zhou Y, Li Y, Zhang Y, Wu J. The author's reply: Development of a simple nomogram to estimate risk for intraoperative complications before partial nephrectomy based on the Mayo Adhesive Probability score combined with the RENAL nephrometry score. Investig Clin Urol 2021. [DOI: 10.4111/icu.20210333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Dachun Jin
- Department of Urology, Daping Hospital, Army Medical Center of the PLA, Army Medical University, Chongqing, China
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojun Tan
- Department of Urology, Nanchong Central Hospital, the Second Clinical Medical College, North Sichuan Medical University, Nanchong, Sichuan, China
| | - Jian Hu
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weili Zhang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhou
- Department of Urology, Nanchong Central Hospital, the Second Clinical Medical College, North Sichuan Medical University, Nanchong, Sichuan, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, the Second Clinical Medical College, North Sichuan Medical University, Nanchong, Sichuan, China
| | - Yuanfeng Zhang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ji Wu
- Department of Urology, Nanchong Central Hospital, the Second Clinical Medical College, North Sichuan Medical University, Nanchong, Sichuan, China
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