Practical and Intuitive Surgical Approach Renal Ranking to Predict Outcomes in the Management of Renal Tumors: A Novel Score Tool

Universidade Federal de São Paulo - UNIFESP, Urology, Dr. Diogo de Faria, 671, Vila Clementino, São Paulo, SP, Brazil, 04037000, +557188800925
Journal of endourology / Endourological Society (Impact Factor: 1.71). 11/2013; 28(4). DOI: 10.1089/end.2013-0148.ECB13
Source: PubMed

ABSTRACT Background and purpose:
Surgery continues to be the main form of treatment for patients with renal tumors. We create a more practical and intuitive score for renal tumor classification.

Patients and methods:
Eighty patients underwent surgery for renal tumors and were prospectively enrolled. The tumors were classified using the following variables: (1) tumor size, (2) endophytic or exophytic tumor, (3) longitudinal location of the tumor, (4) the extent of the impairment of the renal parenchyma, (5) relationship with the renal sinus, and (6) anterior or posterior.

The mean operative time, tumor size,and bleeding increased proportionally to the increased complexity of the tumor measured by scores (P<0.0001, P<0.0001, and P=0.036, respectively). The mean total score was 8.7 points for patients undergoing partial nephrectomy (PN) and 14.4 points for those undergoing radical nephrectomy (RN) (P<0.0001). Patients with larger tumors, completely endophytic, which exceeded the renal medulla, and were centrally located, underwent RN more often (86.7% - P<0.0001, 64% - P=0.01, 77% - P<0.0001, and 78.9% - P<0.0001, respectively). In univariate analysis, RN was associated with tumors larger than 7 cm (P=0.001), tumors that exceeded the renal medullary (<0.001), centrally located tumors (odds ration [OR]=150, P<0.001), and tumors of high complexity (P<0.001). Analysis showed no association between complications and variables in the score. The findings were similar when the tumors were evaluated with the R.E.N.A.L. score system.

Surgical Approach Renal Ranking is a simple, practical and intuitive classification for renal tumors that can be used in the decision-making process and to predict outcomes in the surgical treatment of patients with renal tumors.

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Available from: Matheus Tannus, Aug 07, 2014
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    ABSTRACT: Nephrometry score systems, including RENAL nephrometry, preoperative aspects and dimensions used for an anatomical classification system, C-index, diameter-axial-polar nephrometry, contact surface area score, calculating resected and ischemized volume, renal tumor invasion index, surgical approach renal ranking score, zonal NePhRO score, and renal pelvic score, have been reviewed. Moreover, salient anatomic features like the perinephric fat and vascular variants also have been discussed. We then extract 7 anatomic characteristics, namely tumor size, spatial location, adjacency, exophytic/endophytic extension, vascular variants, pelvic anatomy, and perinephric fat as important features for partial nephrectomy. For novice surgeons, comprehensive and adequate anatomic consideration may help them in their early clinical practice. Copyright © 2015 Elsevier Inc. All rights reserved.
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