Partial Nephrectomy for Renal Cell Carcinoma: Risk Factors for Acute Post-Operative Hemorrhage and Impact on Subsequent Hospital Course and Complete Nephrectomy Rate. An Analysis of 200 Consecutive Cases


Purpose: Clinical guidelines recommend partial nephrectomy (PN) as the preferred method of surgical excision of the small renal tumor whenever feasible. PN has comparable cancer cure rates to that of radical nephrectomy in this setting, and decreased risk of chronic kidney disease. A recognized devastating complication following partial nephrectomy is acute post-operative hemorrhage (APOH) from the reconstructed kidney. Risk factors for hemorrhage following partial nephrectomy remain poorly elucidated, as does the impact of hemorrhage on subsequent hospital stay. Identification of risk factors for hemorrhage may lead to a better understanding of and reduction of this complication. Material and Methods: We utilized a prospectively managed database comprised of patients undergoing open partial nephrectomy at our institution by the same surgical team from January 2006 to July 2012. Clinicopathologic factors assessed APOH for their relationships, including patient age, gender, diabetes, smoking, hypertension, coronary artery disease, American Society of Anesthesia Score (ASA), tumor size, RENAL nephrotomy score, pathologic result, cancer margin status, operative time, and intra-operative blood loss. The impact of APOH on subsequent hospital course was evaluated and compared with the entire cohort. Results: Data were analyzed from 200 consecutive patients. We identified 7 patients (3.5%) who experienced APOH. Compared with the entire cohort, APOH resulted in an increased hospital length of stay (median, 5 days; range, 2-11 days, p = 0.001), an increased transfusion requirement (median, 6 units; range, 1-16 units. p = 0.001), a greater risk of selective angiographic embolization (median, 2 procedures; range, 0-3, p = 0.001), and completion nephrectomy (n = 2, p = 0.001). One patient in the APOH group experienced cardiac arrest and was resuscitated. Clinicopathologic factors associated with

Share and Cite:

J. Cavalcante, A. Perrotti, P. Rabadi, A. McCarthy and M. Perrotti, "Partial Nephrectomy for Renal Cell Carcinoma: Risk Factors for Acute Post-Operative Hemorrhage and Impact on Subsequent Hospital Course and Complete Nephrectomy Rate. An Analysis of 200 Consecutive Cases," International Journal of Clinical Medicine, Vol. 4 No. 12A, 2013, pp. 5-9. doi: 10.4236/ijcm.2013.412A1002.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] S. C. Campbell, A. C. Novick, A. Belldegrun, et al., “Guidelines for Management of the Clinical T1 Renal Mass,” Journal of Urology, Vol. 182, No. 4, 2009, pp. 1271-1279.
[2] M. C. Smaldone, B. Egleston, R. G. Uzzo and A. Kutikov, “Does Partialnephrectomy Result in a Durable Overall Survival Benefit in the Medicare Population?” Journal of Urology, Vol. 188, No. 6, 2012, pp. 2089-2094.
[3] S. P. Kim, R. H. Thompson, S. A. Boorjian, et al., “Comparative Effectiveness for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumor: A Systematic Review and Meta-Analysis,” Journal of Urology, Vol. 188, No. 1, 2012, pp. 51-57.
[4] A. Kutilov and R. G. Uzzo, “The R.E.N.A.L. Nephrotomy Score: A Comprehensive Standardized System for Quantitating Renal Tumor Score, Location and DEPTH,” Journal of Urology, Vol. 182, No. 3, 2009, pp. 844-853.
[5] J. L. Fleiss, “Statistical Methods for Rates and Proportions,” 2nd Edition, John Wiley & Sons, 1981.
[6] American Cancer Society Cancer Facts and Figures, “Atlanta,” American Cancer Society.
[7] W. H. Chow, S. S. Devesa, J. L. Warren and J. F. Fraumeni, “Rising Incidence of Renal Cell Carcinoma in the United States,” JAMA, Vol. 281, No. 17, 1999, pp. 1628-1631.
[8] P. Russo, “Renal Cell Carcinoma Presentation, Staging and Surgical Treatment,” Seminars in Oncology, Vol. 27, No. 2, 2000, pp. 160-166.
[9] J. M. Woldrich, K. Palazzi, S. P. Stroup, et al., “Trends in the Surgical Management of Localized Renal Masses: Thermal Ablation, Partial and Radical Nephrectomy in the USA, 1999-2008,” BJU International, Vol. 111, No. 8, 2012, pp. 1261-1268.
[10] C. J. Kane, K. Mallin, J. Ritchey, et al., “Renal Cell Cancer Stage Migration: Analysis of the National Cancer Data Base,” Cancer, Vol. 113, No. 1, 2008, pp. 78-83.
[11] L. M. Duloban, W. T. Lowrance, P. Russo and W. C. Huang, “Trends in Reanl Tumor Surgery Delivery within the United States,” Cancer, Vol. 116, No. 10, 2010, pp. 2316-2321.
[12] G. Yong, J. D. Villalta, M. V. Meng and J. M. Whitson, “Evolving Practice Patterns for the Management of Small Renal Masses in the United States,” BJU International, Vol. 110, No. 8, 2012, pp. 1156-1161.
[13] W. C. Huang, A. S. Levey, A. M. Serio, et al., “Chronic Kidney Disease after Nephrectomy in Patients with Renal Cortical Tumors: A Retrospective Cohort Study,” The Lancet Oncology, Vol. 7, No. 9, 2006, pp. 735-740.
[14] J. B. Malcolm, A. Bagrodia, I. H. Derveesh, et al., “Comparison for Rates and Risk Factors for Developing Chronic Renal Insufficiency, Proteinuria and Metabolic Acidosis after Radical or Partial Nephrectomy,” BJU International, Vol. 104, No. 4, 2009, pp. 476-481.
[15] C. J. Wright, B. T. Larson, A. F. Fergany, et al., “Nephrectomy Induced Chronic Renal Insufficiency Is Associated with Increased Risk of cardiovascular Death and Death from Any Cause in Patients with Localized cT1b Renal Masses,” Journal of Urology, Vol. 103, No. 4, 2010, pp. 1317-1323.
[16] J. M. Woldrich, R. Mehrazin, W. M. Bazzi, et al., “Comparison of Rates and Risk Factors for Development of Anaemia and Erythropoiesis-Stimulating Agent Utilization after Radical and Partial Nephrectomy,” BJU International, Vol. 109, No. 7, 2011, pp. 1019-1025.
[17] A. Bagrodia, R. Mehrazin, W. M. Bazzi, et al., “Comparison of Rates and Risk Factors for Development of Osteoporosis and Fractures after Radical and Partial Nephrectomy,” Urology, Vol. 78, No. 3, 2011, pp. 614-619.
[18] W. K. Lau, M. I. Blute, A. L. Weaver, et al., “Matched Comparison of Radical Nephrectomy vs Nephron-Sparing Surgery in Patients with Unilateral Renal Cell Carcinoma and a Normal Contralateral Kidney,” Mayo Clinic Proceedings, Vol. 75, No. 12, 2000, pp. 1236-1242.
[19] M. Perrotti, W. J. Badger, D. McLeod, et al., “Does Laparoscpy Beget the Underuse of Partial Nephrectomy for T1 Renal Masses? Competing Treatment Decision Pathways May Influence Utilization,” Journal of Endourology, Vol. 21, No. 10, 2007, pp. 1223-1228.
[20] B. Chughtai, C. Abraham, D. Finn, et al., “Fast Track Open Partial Nephrectomy: Reduced Postoperative Length of Stay with a Goal-Directed Pathway Does Not Compromise Outcome,” Advances in Urology, Vol. 2008, 2008, Article ID: 507543.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.