RENAL nephrometry score predicts surgical outcomes of laparoscopic partial nephrectomy

Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
BJU International (Impact Factor: 3.53). 12/2010; 108(6):876-81. DOI: 10.1111/j.1464-410X.2010.09940.x
Source: PubMed


• To assess the use of the RENAL Nephrometry Score (RNS), which has been proposed as an anatomical classification system for renal masses, aiming to predict surgical outcomes for patients undergoing laparoscopic partial nephrectomy (LPN).
• In the present study, 159 consecutive patients who underwent LPN were reviewed and RNS was calculated for 141 patients with solitary renal masses who had complete radiographic data. • Renal tumours were categorized by RNS as low (nephrometry sum 4-6), intermediate (sum 7-9) and high (sum 10-12).
• Of the 141 patients, there were 43 (30%) low, 91 (65%) intermediate and seven (5%) high score lesions. There was no statistically significant difference in the demographics of the three groups. • There was a significant difference in warm ischaemia time (16 vs 23 vs 31 min; P < 0.001), estimated blood loss (163 vs 312 vs 317 mL; P= 0.034) and length of hospital stay (1.2 vs 1.9 vs 2.3 days; P < 0.001) between the low, intermediate and high score groups, respectively. There was no difference in overall operative time (P= 0.862), transfusion rate (P= 0.665), complication rate (P= 0.419), preoperative creatinine clearance (P= 0.888) or postoperative creatinine clearance (P= 0.473) between the groups. • Sixty-one lesions (43%) were anterior and 80 (57%) were posterior. No difference was found among any intra-operative, pathological or postoperative outcomes when comparing anterior vs posterior lesions.
• In patients undergoing LPN, a higher RNS was significantly associated with an increased estimated blood loss, warm ischaemia time and length of hospital stay. • The RNS may stratify tumours based on the technical difficulty of performing LPN.

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    • "Currently, NSS for early stage renal tumors is a standard therapeutic modality. Laparoscopic partial nephrectomy is considered to be comparable to conventional open surgery with respect to cancer control and perioperative complications [13,14,17,18]. RPN is emerging as an alternative to purely laparoscopic surgery with comparable oncological outcomes and extent of invasiveness [8,9,10,11]. "
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    ABSTRACT: Robot-assisted partial nephrectomy (RPN) has emerged as an alternative treatment for the management of small renal masses. This study was designed to investigate parameters that predict perioperative outcomes during RPN. We retrospectively reviewed the medical records of 113 patients who underwent RPN between September 2008 and May 2012 at the Seoul National University Bundang Hospital. Clinical parameters, including warm ischemia time (WIT), estimated blood loss (EBL), and R.E.N.A.L and PADUA scores, were evaluated to predict perioperative outcomes. Of the 113 patients, 81 were men and 32 were women. The patients' mean age was 53.5 years, and their mean body mass index was 22.3 kg/m(2). Age, gender, and mass laterality had no effect on perioperative complications, WIT, or EBL. Univariate analysis revealed that a distance between the tumor and the collecting system of ≤4 mm or a renal mass size of >4 cm were associated with adverse profiles of complications, WIT, and EBL. However, multivariate analysis showed no association between the predictive parameters and tumor complexity as assessed by nephrometry scores. Tumor size of >4 cm increased the risk of blood loss >300 mL (odds ratio [OR], 3.5; 95% confidence interval [CI],; p=0.016). A distance between the tumor and the collecting system of ≤4 mm was associated with increased risk of WIT exceeding 20 minutes (OR, 2.8; 95% CI,; p=0.012). Tumor size and proximity of the mass to the collecting system showed significant associations with EBL and WIT, respectively, during RPN. The R.E.N.A.L and PADUA nephrometry scoring systems did not predict perioperative outcomes.
    Korean journal of urology 04/2014; 55(4):254-9. DOI:10.4111/kju.2014.55.4.254
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    • "Whereas Mayer et al. [17] reported that the total nephrometry score, as well as the N and R scores, is predictive for extended warm ischemia time and collecting system entry, Hayn et al. [18] showed that higher total nephrometry scores are associated with increased intraoperative estimated blood loss, warm ischemia time, and length of hospital stay. Furthermore, Liu et al. [19] showed that the N score is the single predictive factor for overall complications and postoperative hemorrhage following minimally invasive nephron-sparing surgery. "
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    ABSTRACT: To evaluate the frequency and clinical characteristics of postoperative hemorrhage as a complication of partial nephrectomy. The demographics, physical statistics, tumor size, R.E.N.A.L. nephrometry score, operative method, warm ischemic time, and presence of postoperative hemorrhage and its severity and method of intervention were examined in 300 partial nephrectomy patients in two medical centers (Stanford Medical Center and Kyung Hee University Medical Center) between March 2000 and March 2012. Of the 300 subjects, 13 (4.3%) experienced postoperative hemorrhage severe enough to require intervention more invasive than transfusion (Clavien grade III or higher). Univariate analysis of the bleeding and nonbleeding groups showed that whereas age, ischemic time, tumor size and stage, body mass index, American Society of Anesthesiologists class, and operative method did not differ significantly, the exophyticity (E) score was significantly higher for severe postoperative hemorrhage (p=0.04). However, multivariate analysis showed none of the factors to differ significantly. In most of the cases requiring intervention, selective embolization was sufficient, but in one case explorative laparotomy and nephrectomy were required. Clinical characteristics varied significantly among severe hemorrhage cases, with time of onset ranging from the first to the 30th postoperative day and symptoms presenting in a diverse manner, such as gross hematuria and pleuritic chest pain. Computed tomography and angiographic findings were consistent with either arteriovenous fistula or pseudoaneurysms. Severe hemorrhage after partial nephrectomy is rare. Nonetheless, with the great variability in presenting symptoms and time of onset after surgery, surgeons should exercise great vigilance during the postoperative care of partial nephrectomy patients.
    Korean journal of urology 01/2014; 55(1):17-22. DOI:10.4111/kju.2014.55.1.17
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    Scandinavian journal of gastroenterology. Supplement 02/1979; 54:14-7.
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