Can the R.E.N.A.L Nephrometry Score Preoperatively Predict Postoperative Clinical Outcomes in Patients Undergoing Open and Laparoscopic Partial Nephrectomy?

Roushias, Stella; Vasdev, Nikhil; Ganai, Bhaskar; Mafeld, Sebastian; Rix, D.; Thomas, David C.; Soomro, Naeem

doi:10.1159/000356255

Cited by 21 publications

(19 citation statements)

References 27 publications

(41 reference statements)

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“…Nephrometry scoring systems, such as the C‐index (centrality‐index), PADUA (Preoperative Aspects and Dimensions Used for an Anatomical score) and R.E.N.A.L. score (consists of [R]adius [tumour size as maximal diameter], [E]xophytic/endophytic properties of the tumour, [N]earness of tumour deepest portion to the collecting system or sinus, [A]nterior [a]/posterior [p] descriptor and the [L]ocation relative to the polar line), may assist in decision‐making and planning for PN .…”

Section: Discussionmentioning

confidence: 99%

Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit

et al. 2015

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ObjectivesTo analyse and compare data from the British Association of Urological Surgeons Nephrectomy Audit for perioperative outcomes of partial (PN) and radical nephrectomy (RN) for T1 renal tumours. Patients and MethodsUK consultants were invited to submit data on all patients undergoing nephrectomy between 1 January and 31 December 2012 to a nationally established database using a standard pro forma. Analysis was made on patient demographics, operative technique, and perioperative data/ outcome between PN and RN for T1 tumours. ResultsOverall, data from 6 042 nephrectomies were reported of which 1 768 were performed for T1 renal tumours. Of these, 1 082 (61.2%) were RNs and 686 (38.8%) were PNs. The mean age of patients undergoing PN was lower (PN 59 years vs RN 64 years; P < 0.001) and so was the WHO performance score (PN 0.4 vs RN 0.7; P < 0.001). PN for the treatment of T1a tumours (≤4 cm) accounted for 55.6% of procedures, of which 43.9% were performed using a minimally invasive technique. For T1b tumours (4-7 cm), 18.9% of patients underwent PN, in 33.3% of which a minimally invasive technique was adopted. The vast majority of RNs for T1 tumours were performed using a minimally invasive technique (90.3%). Of the laparoscopic PNs, 30.5% were robot-assisted. There was no significant difference in overall intraoperative complications between the RN and PN groups (4% vs 4.3%; P = 0.79). However, PN accounted for a higher overall postoperative complications rate (RN 11.3% vs PN 17.6%; P < 0.001). RN was associated with a markedly reduced risk of severe surgical complications (Clavien Dindo classification grade ≥3) compared with PN even after adjusting for technique (odds ratio 0.30; P = 0.002). Operation time between RN and PN was comparable (141 vs 145 min; P = 0.25). Blood loss was less in the RN group (mean for RN 165 vs PN 323 mL; P < 0.001); however, transfusion rates were similar (3.2% vs 2.6%; P = 0.47). RN was associated with a shorter length of stay (median 4 vs 5 days; P < 0.001). A direct comparison between robot-assisted and laparoscopic PN showed no significant differences in operation time, blood loss, warm ischaemia time, and intraoperative and postoperative complications. ConclusionsPN was the method of choice for treatment of T1a tumours whereas RN was preferred for T1b tumours. Minimally invasive techniques have been widely adopted for RN but not for PN. Despite the advances in surgical technique, a substantial risk of postoperative complications remains with PN.

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Section: Discussionmentioning

confidence: 99%

Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit

et al. 2015

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“…Some studies showed comparable PSM rates for central and peripheral tumors [51], others a higher risk for central located tumors [52,53]. In the last years, some studies stratified PSM rates according to the risk categories defined by nephrometry scores [8,16,34]. No study demonstrated a significant impact of nephrometry score on risk of PSMs.…”

Section: Discussionmentioning

confidence: 99%

Positive Surgical Margins After Partial Nephrectomy: A Systematic Review and Meta-Analysis of Comparative Studies

Ficarra

Crestani

Inferrera

et al. 2018

KCA

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Objective: We performed an update of previous reviews of the literature to provide an overview on incidence, predictive factors, management and prognosis of positive surgical margins (PSMs) after partial nephrectomy (PN) including recent surgical series and studies comparing different approaches and techniques. Material and methods: A literature search was performed from January 2013 to January 2018 using the Medline database. The search strategy included a free-text protocol using the term "nephron-sparing surgery" OR "partial nephrectomy" AND "positive surgical margins" across the title and abstract fields of the records. From each selected study, we extracted the following data: number of analyzed patients, study design, approach and surgical technique used, PSMs rate, pathological features, type of PSMs treatment, mean (median) follow-up duration and final patient status. Meta-analysis was conducted using Review Manager software v. 5.2 (Cochrane Collaboration, Oxford, UK). Results: We selected a total of 36 (48%) studies. All studies were retrospective and the best statistical method used for comparison was the matched-pair analysis (level 4). Overall, 45,786 patients treated with PN were included in the selected studies. PSMs were reported in a total of 3,093 (6.7%) patients. The mean estimated PSMs rate was 7%, 5% and 4.3% in patients who underwent robot-assisted PN (RAPN), laparoscopic PN (LPN) and open PN (OPN), respectively. Comparative studies showed a significant advantage in favor of OPN compared with minimally invasive approach, while RAPN showed more favourable PSMs risk compared with LPN (odds ratio 3.02, 95% confidence intervals 2.05-4.45). No differences were detected stratifying data according to other surgical or tumor-related factors. Tumor size, nuclear grading and pT3a stage represent the most important predictors of PSMs. In 6,809 patients, follow-up data were available. Only 101 (1.4%) local recurrences and 88 (1.3%) distant recurrences were observed both in PSMs and negative surgical margins subgroups. PSMs were associated with a significant increased risk of local recurrence with a significant impact on local recurrence-free survival and metastasis-free survival. However, a significant impact on cancer-specific and overall survival could not be demonstrated.

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“…A full‐text review of the last 127 articles excluded those articles that could not obtain data and did not conform to the type of research. A total of 20 studies met the requirements of meta‐analysis …”

Section: Resultsmentioning

confidence: 99%

The value of renal score in both determining surgical strategies and predicting complications for renal cell carcinoma: A systematic review and meta‐analysis

Shi

Zu²,

Shan

et al. 2020

Cancer Medicine

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Objectives: Radical nephrectomy (RN) was the standard treatment for renal cell carcinoma (RCC). However, recent studies have found that partial nephrectomy (PN) could achieve similar effects as radical nephrectomy, and has the advantages of less bleeding and shorter hospital stay. The choice of surgical strategies has become a concern of clinicians, which could be guided by renal score introduced by Kutikov et al Therefore, we conducted this meta-analysis to clarify the value of renal score of determining surgical strategies and predicting complications. Methods: The keywords "RENAL score," "renal nephrometry score," or "nephrometry score" were used to retrieve electronic databases for relevant literature up to Feb 2020, including PubMed, Web of Science, and the Cochrane library. Surgical strategies and complications are outcome measures. Risk ratio (RR) with 95% confidence intervals (CI) is applied to assess the effect size. Results: A total of 20 studies met the selection criteria for meta-analysis. There was significant difference in RN operation rate for each subgroup (low-moderate: RR = 3.50, 95% Cl = 2.60-4.71, P < .001; low-high: RR = 6.29, 95% Cl = 4.40-9.00, P < .001; moderate-high: RR = 1.80, 95% Cl = 1.39-2.32, P < .001).The overall incidence of complications from high renal score group was significantly higher than that in low renal score group (low-moderate: RR = 1.32, 95% Cl = 1.03-1.69, P = .026; low-high: RR = 2.45, 95% Cl = 1.48-4.07, P = .001; moderate-high: RR = 1.75, 95% Cl = 1.17-2.61, P = .007). Conclusions: This meta-analysis indicated that renal score is an efficient tool for determining surgical strategies and predicting complications in PN. More prospective research is essential to verify the predictive value of renal score. K E Y W O R D Scomplications, meta-analysis, Renal cell carcinoma, RENAL score, surgical strategiesThis is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Can the R.E.N.A.L Nephrometry Score Preoperatively Predict Postoperative Clinical Outcomes in Patients Undergoing Open and Laparoscopic Partial Nephrectomy?

Cited by 21 publications

References 27 publications

Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit

Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit

Positive Surgical Margins After Partial Nephrectomy: A Systematic Review and Meta-Analysis of Comparative Studies

The value of renal score in both determining surgical strategies and predicting complications for renal cell carcinoma: A systematic review and meta‐analysis

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