Session: MP58: Kidney Cancer: Localized: Surgical Therapy III
MP58-15: Lawton Instrumental Activities of Daily Living scale identifies patients at high-risk of adverse outcomes after kidney surgery for renal cancer: a prospective clinical study
Introduction: Frailty is a clinical syndrome associated with delayed recovery and suboptimal outcomes after surgery. Frailty scales have been suggested for identifying frailty before kidney cancer surgery. In this prospective clinical study, we aimed at assessing the role of Lawton Instrumental Activities of Daily Living (IADL) scale in predicting surgical outcomes in patients undergoing partial or radical nephrectomy for renal cell carcinoma (RCC). Methods: Between January 2021 and June 2022, 98 consecutive patients surgically treated for cT1-2 RCC were prospectively enrolled. The IADL scale was calculated for each patient at hospital admission. Postoperative complications were prospectively collected using Clavien-Dindo classification. Acute kidney injury (AKI) was defined according to the RIFLE criteria. Multivariable logistic and linear regression models tested the association between iADL score and postoperative complications, as well as length of stay (LOS) and postoperative AKI, after adjusting for age, preoperative eGFR, blood loss and tumor characteristics. Results: Overall, 98 patients were included. Of these, 21 (21%) had IADL <6. Median age at surgery and clinical size were 62 [Interquartile range (IQR): 53-71] years and 5 (IQR: 3.4-7) cm. Median preoperative eGFR was 70 (IQR: 56-91) mL/min. Finally, median LOS was 5 (IQR: 4-7) days. Overall, the rate of postoperative complications was 13% (5% of major complications defined as Clavien-Dindo >3). Overall, 22 (22%) out of 98 patients experienced postoperative AKI. At MVA, increasing IADL score predicted lower risk of overall complications [Odds ratio (OR): 0.35, 95%CI 0.22-0.48; p<0.001] and shorter LOS (Relative risk: 0.28, 95%CI 0.19-0.41; p<0.001). Moreover, increasing IADL was independently associated with lower risk of postoperative AKI after surgery (OR: 0.64, 95%CI 0.47-0.88; p<0.01). Conclusions: Assessing preoperative IADL score allows the identification of patients at increased risk of suboptimal outcomes after surgery for kidney cancer. Therefore, frailty assessment allows the stratification of surgical risks and, potentially, the implementation of dedicated management which may help in protecting frail patients from suboptimal outcomes. SOURCE OF Funding: None
