Anatomic Features Involved in Technical Complexity of Partial Nephrectomy

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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“…Although some studies have been showing association between them and surgical outcomes, no one have accuracy strongly tested and validated (31). …”

Section: Discussionmentioning

confidence: 99%

Predicting outcomes in partial nephrectomy: is the renal score useful?

et al. 2017

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“…Patient and disease-specific characteristics are associated with an operation's technical complexity [1][2][3][4][5][6]. Hence, a methodical preparation towards challenging surgical procedures, encompassing patient-specific features, may have a significant effect on improving both the quality and outcome of surgery.…”

Section: Introductionmentioning

confidence: 99%

Is patient-specific pre-operative preparation feasible in a clinical environment? A systematic review and meta-analysis

Yiasemidou

Glassman

Jayne

et al. 2018

Computer Assisted Surgery

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Technical difficulty of an operation is associated with patient and disease characteristics, indicating the necessity for surgeons to exercise patient-specific preparation. Such methods have been shown to be effective in the simulation suite, however, application in a real clinical environment has been sporadic. This systematic review attempts to answer if patient-specific preparation in challenging surgical procedures is feasible. A systematic review of OvidMedline, Embase and all Evidence Based Medicine review databases, was conducted in search of studies who described surgical rehearsals in all specialties. Following the application of defined inclusion and exclusion criteria relevant data were extracted and summarised. Descriptive synthesis was performed for all included studies and meta-analysis of data was applied when possible. Of fourty-nine studies included, thirty-seven were case-series, ten were non-randomised comparative trials and two randomised controlled trials. Accuracy of applied methods ranged from 66.7 to 100% and a good outcome was seen in 60-100% of operations. Meta-analysis of studies comparing rehearsals to real procedures (same patients) showed that simulated procedures were significantly faster than real ones (SMD ¼ À1.56 [À2.19, À0.93] p < 0.00001) but were similar in other outcomes (fluoroscopy time: SMD ¼ À0.1 [À0.63, 0.42] p ¼ 0.7, fluoroscopy volume: SMD ¼ À0.43[À0.97, 0.11], p ¼ 0.12). Meta-analysis of studies comparing pre-operative rehearsals to standard treatment (two distinct groups of patients), demonstrated that real procedures were performed quicker if pre-operative rehearsal took place (SMD ¼ À0.47 [À0.79, À0.16], P ¼ 0.003) but the immediate clinical outcome was similar for practiced and not practiced operations (SMD ¼0.03[À0.23, 0.29], p ¼ 0.82). Current evidence suggests that patient-specific pre-operative preparation is feasible and safe and decreases operational time.

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“…Recently, several studies showed that having no functional residual renal volume and postoperative renal recovery can also affect postoperative renal functional outcome which was difficult to have precise prediction before surgery 13–15 . Advances in PN techniques have helped to maximize parenchymal volume preservation, leading to the need for a new parameter to predict RPV-unrelated postoperative ePD10 16, 17 .…”

Section: Discussionmentioning

confidence: 99%

“…To study the mechanism behind this clinical finding, we reviewed the anatomy features of renal artery divisions and here proposed two possible explanations. Firstly, PAC III (segmental artery) reflected a good cut-off value for the prediction of outcomes, because end arteries do not provide adequate collateral circulation 16, 17 . Segmental artery ligation causes irreversible ischemia to the kidney segment and subsequent segmental renal infarction 18 .…”

Section: Discussionmentioning

confidence: 99%

Peritumoral Artery Scoring System: a Novel Scoring System to Predict Renal Function Outcome after Laparoscopic Partial Nephrectomy

Zhang

Huang

et al. 2017

Sci Rep

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The present study aimed to assess the impact of peritumoral artery characteristics on renal function outcome prediction using a novel Peritumoral Artery Scoring System based on computed tomography arteriography. Peritumoral artery characteristics and renal function were evaluated in 220 patients who underwent laparoscopic partial nephrectomy and then validate in 51 patients with split and total glomerular filtration rate (GFR). In particular, peritumoral artery classification and diameter were measured to assign arteries into low, moderate, and high Peritumoral Artery Scoring System risk categories. Univariable and multivariable logistic regression analyses were then used to determine risk factors for major renal functional decline. The Peritumoral Artery Scoring System and four other nephrometry systems were compared using receiver operating characteristic curve analysis. The Peritumoral Artery Scoring System was significantly superior to the other systems for predicting postoperative renal function decline (p < 0.001). In receiver operating characteristic analysis, our category system was a superior independent predictor of estimated glomerular filtration rate (eGFR) decline (area-under-the-curve = 0.865, p < 0.001) and total GFR decline (area-under-the-curve = 0.796, p < 0.001), and split GFR decline (area-under-the-curve = 0.841, p < 0.001). Peritumoral artery characteristics were independent predictors of renal function outcome after laparoscopic partial nephrectomy.

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Anatomic Features Involved in Technical Complexity of Partial Nephrectomy

Cited by 31 publications

References 26 publications

Predicting outcomes in partial nephrectomy: is the renal score useful?

Predicting outcomes in partial nephrectomy: is the renal score useful?

Is patient-specific pre-operative preparation feasible in a clinical environment? A systematic review and meta-analysis

Peritumoral Artery Scoring System: a Novel Scoring System to Predict Renal Function Outcome after Laparoscopic Partial Nephrectomy

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