Adult urologyUse of American Society of Anesthesiologists physical status classification to assess perioperative risk in patients undergoing radical nephrectomy for renal cell carcinoma
Section snippets
Material and methods
A retrospective study was performed (under institutional review board approval; protocol No. KCP 99-233) with the outcome assessment determined on the basis of a chart review of 1087 patients who underwent surgery for renal cell carcinoma (RCC) between 1989 and 2001. All patients with metastatic disease and nodal disease were included, in addition to those with localized disease. Patients with RCC who did not undergo nephrectomy as part of their cancer treatment, patients with bilateral
Results
The patient and tumor characteristics are presented in Table I. The patients with ASA classification 3 (IR) were older (63 years versus 58 years) than those with ASA classification 1 or 2 (LR; P = 0.04). IR patients presented with metastatic disease (40%) more often than LR patients (31%) did (P = 0.03). However, no statistically significant differences were found in male versus female distribution, 1997 T stage, tumor size, nodal involvement, vascular or IVC involvement, rate of partial
Comment
Recently, investigators have demonstrated the importance of the Eastern Cooperative Oncology Group performance status (ECOG PS)7 in the prognostication of patients with RCC.8, 9, 10 However, although some surgeons may use the ECOG PS to help assess perioperative risk, scant mention is made in published reports of the use of ECOG PS to determine the risk of postoperative complications. Furthermore, unlike the ASA scale, the ECOG PS is determined on the basis of the effects that the malignancy
Conclusions
The incidence of perioperative and postoperative morbidity in IR (ASA classification 3) patients was no worse than in patients in the LR (ASA classification 1 or 2) group in patients undergoing partial or radical nephrectomy. The IR patients did have a slightly, but statistically significant, greater EBL on average, leading to greater transfusion rates. Renal surgery can be performed with acceptable morbidity in patients with comorbid disease as defined by an ASA physical status of 3.
Despite
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