Are renal tumour scoring systems better than clinical judgement at predicting partial nephrectomy complexity?

Abstract

Introduction: We aimed to determine how renal tumour scoring systems, such as RENAL, PADUA, and Centrality (C)-index, compare to clinical judgement at predicting time required for tumour removal and kidney reconstruction during partial nephrectomy. Methods: A consecutive cohort of partial nephrectomy patients treated at The Ottawa Hospital, a tertiary care uro-oncological centre, was retrospectively reviewed. Preoperative axial images were reviewed by four experienced urological oncologists who independently rated the complexity of a partial nephrectomy from 1-10 to generate a clinical judgement score. Two independent reviewers determined the RENAL, PADUA, and C-index scores. The time to complete tumour resection and renal reconstruction during partial nephrectomy was prospectively recorded. Results: During the study period, 104 partial nephrectomies were performed. The mean partial nephrectomy complexity score based on clinical judgement was 3.4 (standard deviation [SD] 2.1) out of 10. There was good agreement between surgeons in assessing tumour complexity (intraclass correlation coefficient 0.72; 95% confidence interval [CI] 0.65, 0.78). The mean RENAL score was 6.7 (SD 1.6) out of a maximum of 12, the mean PADUA score was 8.5 (SD 1.5) out of a maximum of 14, and the mean C-index score was 3.8 (SD 2). Mean resection and reconstruction time was 24 minutes (SD 10 minutes). The correlation between clinical judgement score and time was 0.27 (p=0.005). The correlation between renal tumour scoring systems and time was 0.20 (p=0.04) for RENAL, 0.21 (p=0.03) for C-index, and 0.26 (p=0.007) for PADUA. RENAL and PADUA scores were significantly associated with surgical and total complications. Conclusions: The majority of variance in ischemia time is not explained by clinical judgement or renal tumour scoring systems. Renal tumour scoring systems were not better than the clinical judgement of urological oncologists at predicting ischemia time during partial nephrectomy.

Factors influencing warm ischemia time in robot-assisted partial nephrectomy change depending on the surgeon’s experience

“…The RENAL score is a well-validated method for this purpose and is used to evaluate RALPN patients. However, these scores are primarily validated from laparoscopic partial nephrectomies and may be inadequate for assessing robotic procedure di culties [10,21]. Nevertheless, each RENAL score component focused on representative points regarding the kidney tumor dissection.…”

“…The RENAL nephrometry score (Radius [tumor size], Exophytic/endophytic properties, Nearness of the tumor to the collecting system, Anterior/posterior, Location relative to the polar line; RENAL score) is used to predict surgical di culty in RALPN and laparoscopic partial nephrectomy patients [8]. However, it remains unclear what RENAL score or other clinical factors affect WIT in RALPN [9,10]. Since most previous studies were assessed a predicting factor of WIT only depending on dividing patients into groups by clinical factors and/or surgical techniques, a real factor could be covered up due to many confounders [11][12][13].…”

Factors influencing warm ischemia time in robot-assisted partial nephrectomy change depending on the surgeon’s experience

“…The RENAL nephrometry score (radius [tumor size], exophytic/endophytic properties, nearness of the tumor to the collecting system, anterior/posterior, location relative to the polar line; RENAL score) is used to predict surgical difficulty in RALPN and laparoscopic partial nephrectomy patients [ 8 ]. However, it remains unclear what RENAL score or other clinical factors affect WIT in RALPN [ 9 , 10 ]. Since most previous studies assessed a predicting factor of WIT only depending on dividing patients into groups by clinical factors and/or surgical techniques, a real factor could be covered up due to many confounders [ 11 – 13 ].…”

Predicting intra‐operative and postoperative consequential events using machine‐learning techniques in patients undergoing robot‐assisted partial nephrectomy: a Vattikuti Collective Quality Initiative database study

“…Significant efforts have been made to develop tools to individualize patient risk profiles for better surgical planning. Instruments such as the RENAL [7], PADUA [8] and MAP [9] scores are mainly based on preoperative imaging; however, their utility in clinical practice remains questionable [10,11]. Surgical risk calculators were made with suboptimal predictability and virtually no clinical utility [12].…”