Nephrometry scores and perioperative outcomes following robotic partial nephrectomy

Abstract

Objectives:Based on imaging features, nephrometry scoring systems have been conceived to create a standardized and reproducible way to characterize renal tumor anatomy. However, less is known about which of these individual measures are important with regard to clinically relevant perioperative outcomes such as ischemia time (IT), estimated blood loss (EBL), length of hospital stay (LOS), and change in estimated glomerular filtration rate (eGFR) after robotic partial nephrectomy (PN). We aimed to assess the utility of the RENAL and PADUA scores, their subscales, and C-index for predicting these outcomes.Materials and Methods:We analyzed imaging studies from 283 patients who underwent robotic PN between 2008 and 2014 to assign nephrometry scores (NS): PADUA, RENAL and C-index. Univariate linear regression was used to assess whether the NS or any of their subscales were associated with EBL or IT. Multivariable linear regression and linear regression models were created to assess LOS and eGFR.Results:The three NS were significantly associated with EBL, IT, LOS, and eGFR at 12 months after surgery. All subscales with the exception of anterior/posterior were significantly associated with EBL and IT. Collecting system, renal rim location, renal sinus, exophytic/endophytic, and nearness to collecting system were significant predictors for LOS. Only renal rim location, renal sinus invasion and polar location were significantly associated with eGFR at 12 months.Conclusions:Tumor size and depth are important characteristics for predicting robotic PN outcomes and thus could be used individually as a simplified way to report tumors features for research and patient counseling purposes.

Open and Laparoscopic Partial Nephrectomy: Comparison and Validation of Preoperative Scoring Systems, Including PADUA, RENAL, ABC Nephrometric Scores and Perinephric Fat Evaluation with Mayo Adhesive Probability Score

“…They concluded these features could be used individually as a simplified way to report tumor features for research and patient counseling purposes. 26 Ficarra et al proposed recently the simplified PADUA REnal score. This new SPARE score is comprised of only four variables instead of the original six and its accuracy to predict overall complications is similar to that of the original PADUA score.…”

Parallel comparison of R.E.N.A.L., PADUA, and C‐index scoring systems in predicting outcomes after partial nephrectomy: A systematic review and meta‐analysis

“…Investigators have published contradictory results on this issue. Corradi et al 46 reporting data from 283 patients who underwent RPN, found a significant correlation between the three scores and EBL and LOS. In the study by Kwon et al 23 , all the three scores were useful for predicting EBL, and at least one could correlate with OT and LOS.…”

Robot-Assisted Partial Nephrectomy: Evolving Techniques

“…In addition the patient-side assistant should be appropriately skilled in handling instruments safely and deploying ligature clips. All cases should be subjected to nephrometry scoring (PADUA and RENAL) and a thorough imaging review preoperatively to predict operative complexities and postoperative complications [13][14][15][16]. We incorporate the PADUA score due to its standardised use across the national nephrectomy register, collected by the British Association of Urological Surgeons.…”