Introduction and Objective The R.E.N.A.L. nephrometry system (RNS) has been validated in multiple open, laparoscopic and robotic partial nephrectomy series. The aim of this study was to test the accuracy of R.E.N.A.L. nephrometry system in predicting perioperative outcomes in surgical treatment of kidney tumors <7.0cm in a prospective model.Materials and Methods Seventy-one patients were selected and included in this prospective study. We evaluate the accuracy of RNS in predicting perioperative outcomes (WIT, OT, EBL, LOS, conversion, complications and surgical margins) in partial nephrectomy using ROC curves, univariate and multivariate analyses. R.E.N.A.L. was divided in 3 groups: low complexity (LC), medium complexity (MC) and high complexity (HC).Results No patients in LC group had WIT >20 min, versus 41.4% and 64.3% MC and HC groups respectively (p=0.03); AUC=0.643 (p=0.07). RNS was associated with convertion rate (LC:28.6% ; MC:47.6%; HC:77.3%, p=0.02). Patients with RNS <8 were most often subjected to partial nephrectomy (93% x 72%, p=0.03) and laparoscopic partial nephrectomy (56.8% x 28%, p=0.02), AUC=0.715 (p=0.002). The RNS was also associated with operative time. Patients with a score >8 had 6.06 times greater chance of having a surgery duration >180 min. (p=0.017), AUC=0.63 (p=0.059). R.E.N.A.L. score did not correlate with EBL, complications (Clavien >3), LOS or positive surgical margin.Conclusion R.E.N.A.L. score was a good method in predicting surgical access route and type of nephrectomy. Also was associated with OT and WIT, but with weak accuracy. Although, RNS was not associated with Clavien >3, EBL, LOS or positive surgical margin.

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Aim: To test the hypothesis that R.E.N.A.L. nephrometry score is able to predict surgical conversion, from laparoscopic to open nephrectomy, or totalization, from partial to total nephrectomy. Methods: Between January 2010 and June 2012, 320 patients underwent radical or partial nephrectomy at a Tertiary Institution, of which 173 (54.1%) had a tumor <7cm. Of these, 71 (41%) patients were selected for the prospective study according to inclusion and exclusion criteria. Score's accuracy in predicting surgical conversion rate was analyzed by using ROC curve and it's best cutoff point was identified. Results:The accuracy of R.E.N.A.L. nephrometry score in predicting conversion rate demonstrated an AUC of 0.715 (95% CI: 0.595-0.836; p=0.002). By evaluating a cutoff point, it was found 46% sensitivity and 78% specificity for R.E.N.A.L. >9. From patients who underwent totalization, 4/46 (8.9%) had a R.E.N.A.L. score <9 and 7/25 (28%) had a R.E.N.A.L. score ≥9, OR 4.08, p=0.03. Conclusion:R.E.N.A.L. nephrometry score can help predicting the need of total nephrectomy or conversion to open surgery. Renal unit loss was associated with high complexity tumors (score ≥9), with this cutoff point representing a fourfold higher chance of conversion from partial nephrectomy to radical in treatment of renal cancer.