Predicting hemorrhagic complications in robotic-assisted partial nephrectomy for renal tumors: simplifying risk assessment with tumor diameter and depth.

Abstract

Purpose: Robotic-assisted partial nephrectomy has emerged as the standard surgical procedure for managing localized kidney cancers, with bleeding risk being a primary clinical consideration. This investigation seeks to establish simple predictive indicators for hemorrhage-related adverse events.

Materials and methods: We performed a retrospective review of sequential patients undergoing robotic-assisted partial nephrectomy at a single tertiary medical center. Patient records and radiographic studies were analyzed to obtain clinical parameters. Tumor characteristics (size, infiltration depth, and standardized nephrometry measurements) were assessed by an experienced radiologist. Bleeding-related outcomes included surgical blood loss, transfusion requirements, reoperation, and need for angiographic intervention. Predictive factors for hemorrhagic events were examined statistically.

Results: The study included 260 participants. Median nephrometry scores were 8.5 (PADUA) and 7.0 (RENAL). The average tumor size measured 39.1 mm with a mean penetration depth of 2.02 mm, and the median renal ischemia duration was 25.5 min. Mean operative hemorrhage volume was 147 ml. Transfusion was administered to 12.7% of cases, with 3.5% experiencing significant hemorrhagic complications. Tumor size independently predicted both intraoperative bleeding and transfusion needs, while invasion depth showed a strong association with severe bleeding events.

Conclusions: Compared to comprehensive nephrometry systems, basic tumor measurements (diameter and depth) effectively anticipate bleeding risks. These straightforward parameters enable clinicians to identify high-risk patients and initiate preventive measures.