Implementation and external validation of Preoperative Aspects and
Dimensions Used for an Anatomical (PADUA) score for predicting
complications in 74 consecutive partial nephrectomies
Study Type Prognosis (case series) Level of Evidence 4 What’s known on
the subject? and What does the study add? Partial nephrectomy (PN) is
the gold standard operation for small renal tumours. The decision for or
against a PN has been based mostly on preoperative radiological
evaluation of the tumour. Three nephrometry scoring systems have been
recently proposed for prediction of postoperative complications of PN
(RENAL, C-index and PADUA). We validate externally the accuracy of the
PADUA system and suggest for the first time a novel scoring system,
based on the original PADUA system, which implements three other
significant factors for the postoperative course of a partial.
OBJECTIVE To externally validate the Preoperative Aspects and Dimensions
Used for an Anatomical (PADUA) classification of renal tumours managed
by partial nephrectomy (PN).
PATIENTS AND METHODS Seventy-four consecutive patients in a single
academic tertiary institution underwent open PN.
Incidence of 90-day complications was stratified by several
clinicopathological variables, such as gender, age of the patient,
hospital stay, pathology report, tumour characteristics and positive
surgical margins. PADUA scores were given to each case. The severity of
complications was also categorized with the Clavien system.
RESULTS The optimal threshold of PADUA for the prediction of
complications was 8 with a sensitivity equal to 90.9% and a specificity
equal to 77.8% (area under the curve [AUC], 0.89; 95% confidence
interval [CI], 0.731.00). Multivariate analysis revealed that that
PADUA is an independent predictor for the risk of complications. Also,
PADUA score =8 identified a group of patients with almost 20-fold higher
risk of complications (hazard ratio [HR]= 19.82; 95% CI, 1.7928.35;
P= 0.015). Patients with papillary histology had greater risk for
complications than those with clear-cell tumours (HR = 4.88; 95% CI,
1.3417.76; P= 0.016).
CONCLUSIONS The PADUA score is a simple anatomical system that predicts
the risk of postoperative complications. This is the first external
validation of this system for open PN from a single centre. The authors
believe that PADUA is an efficient tool, since the only variable of the
present study that predicted a higher incidence of complications was the
histology type, which is determined after surgery.
However, it should be applied to laparoscopic and robot-assisted series
and it could also include the ischaemia time and surgeon experience in
the overall scoring to be complete
