Abstract:Nephrometry scores are designed to characterize tumors and stratify the surgical complexity. It remains unclear as to which nephrometry score can accurately predict the surgical outcomes. We aimed to assess the utility of radius, exophytic/endophytic, nearness, anterior/posterior, location (RENAL), preoperative aspects and dimensions used for anatomic classifications (PADUA), and centrality index (C-index) nephrometry scores for predicting the strict Trifecta achievement from a single institution series roboti… Show more
“…в исследовании изучили возможность предсказания шкал RENAL, PADUA и C-index для достижения трифекты у 91 пациента, перенесшего роботическую резекцию опухоли почки. Все шкалы показали хорошую предиктивность достижения трифекты и были независимы друг от друга (площади под кривой (AUC) для RENAL, PADUA и C-index составили 0,782, 0,838 и 0,828 соответственно), а также ни одна шкала по своей результативности не уступала остальным [17].…”
Background. Modern imaging methods make it possible to detect kidney tumors at early stages which, along with active development of laparoscopic technologies, has led to an increase in the number of nephron-sparing surgeries and their effectiveness. The RENAL, PADUA, C-index, ZONAL NePhRO, and SPARE nephrometry score systems are actively used to predict outcomes of partial nephrectomy.Aim. To evaluate the effectiveness of nephrometry scores in predicting the results of minimally invasive partial nephrectomy.Materials and methods. The data on 90 patients who underwent laparoscopic or robotic partial nephrectomy at the Urology Center of the Mariinsky Hospital from September 2021 to May 2023 were retrospectively evaluated. There were 43 men (47.8 %) and 47 women (52.2 %). The median age of patients was 61 years (interquartile range (IQR) 48–69). Tumor of the left kidney was diagnosed in 46 (51.1 %) patients, and tumor of the right kidney in 44 (48.9 %) patients.Results. Mean operative time was 132 ± 39 minutes. Median warm ischemia time and intraoperative blood loss were 15 minutes (IQR 12–20 min) and 150 mL (IQR 70–257.5), respectively. Mean hemoglobin level and red blood cell count before surgery were 132 ± 15 g/L and 4.6 ± 0.63 × 1012/L, respectively. After the surgery, the mean values were 119 ± 16 g/L and 4.06 ± 0.6 × 1012/L, respectively. Median creatinine and mean glomerular filtration rate before surgery were 83.5 µmol/L (IQR 72–97 µmol/L) and 76.9 ± 21 mL/min, respectively; in the early postoperative period, 83 µmol/L (IQR 70–100 µmol/L) and 76.4 ± 24 mL/min, respectively. The strongest relationship was established between the RENAL and PADUA scores (r = 0.907; p <0.001), a slightly weaker relationship was found for the PADUA and SPARE scores, as well as PADUA and C-index (r = 0.856; p <0.001 and r = –0.785; p <0.001, respectively). The RENAL score showed high predictive value in assessing the volume of intraoperative blood loss and operative time (r = 0.881; p = 0.001 and r = 0.854; p <0.001, respectively). The PADUA scale demonstrated high predictive efficiency for warm ischemia time (r = 0.775; p = 0.001). C-index significantly predicted the volume of intraoperative blood loss and operative time (r = –0.807; p <0.001 and r = –0.797; p = 0.001, respectively).Conclusion. All of the above nephrometry scores showed high predictive efficiency, but the RENAL and PADUA scores were the most valuable.
“…в исследовании изучили возможность предсказания шкал RENAL, PADUA и C-index для достижения трифекты у 91 пациента, перенесшего роботическую резекцию опухоли почки. Все шкалы показали хорошую предиктивность достижения трифекты и были независимы друг от друга (площади под кривой (AUC) для RENAL, PADUA и C-index составили 0,782, 0,838 и 0,828 соответственно), а также ни одна шкала по своей результативности не уступала остальным [17].…”
Background. Modern imaging methods make it possible to detect kidney tumors at early stages which, along with active development of laparoscopic technologies, has led to an increase in the number of nephron-sparing surgeries and their effectiveness. The RENAL, PADUA, C-index, ZONAL NePhRO, and SPARE nephrometry score systems are actively used to predict outcomes of partial nephrectomy.Aim. To evaluate the effectiveness of nephrometry scores in predicting the results of minimally invasive partial nephrectomy.Materials and methods. The data on 90 patients who underwent laparoscopic or robotic partial nephrectomy at the Urology Center of the Mariinsky Hospital from September 2021 to May 2023 were retrospectively evaluated. There were 43 men (47.8 %) and 47 women (52.2 %). The median age of patients was 61 years (interquartile range (IQR) 48–69). Tumor of the left kidney was diagnosed in 46 (51.1 %) patients, and tumor of the right kidney in 44 (48.9 %) patients.Results. Mean operative time was 132 ± 39 minutes. Median warm ischemia time and intraoperative blood loss were 15 minutes (IQR 12–20 min) and 150 mL (IQR 70–257.5), respectively. Mean hemoglobin level and red blood cell count before surgery were 132 ± 15 g/L and 4.6 ± 0.63 × 1012/L, respectively. After the surgery, the mean values were 119 ± 16 g/L and 4.06 ± 0.6 × 1012/L, respectively. Median creatinine and mean glomerular filtration rate before surgery were 83.5 µmol/L (IQR 72–97 µmol/L) and 76.9 ± 21 mL/min, respectively; in the early postoperative period, 83 µmol/L (IQR 70–100 µmol/L) and 76.4 ± 24 mL/min, respectively. The strongest relationship was established between the RENAL and PADUA scores (r = 0.907; p <0.001), a slightly weaker relationship was found for the PADUA and SPARE scores, as well as PADUA and C-index (r = 0.856; p <0.001 and r = –0.785; p <0.001, respectively). The RENAL score showed high predictive value in assessing the volume of intraoperative blood loss and operative time (r = 0.881; p = 0.001 and r = 0.854; p <0.001, respectively). The PADUA scale demonstrated high predictive efficiency for warm ischemia time (r = 0.775; p = 0.001). C-index significantly predicted the volume of intraoperative blood loss and operative time (r = –0.807; p <0.001 and r = –0.797; p = 0.001, respectively).Conclusion. All of the above nephrometry scores showed high predictive efficiency, but the RENAL and PADUA scores were the most valuable.
“…In addition, multiple studies have analyzed the relationship between surgical approach and trifecta outcome [ 4 , 8 , 10 , 26 ]. In a direct comparison between open and robotic PN, Campi et al found that robotic PN was a significant predictor for achieving trifecta outcomes [ 27 ].…”
Section: Discussionmentioning
confidence: 99%
“…nephrometry score is an established anatomical system for categorizing complexity of renal tumors prior to surgery. Multiple studies have shown Nephrometry scores strongly correlate with effective PN [ 2 – 5 ] and predicts the attaining of “trifecta outcome” (reduced global renal ischemia, minimal complications, and high rates of negative margins) [ 4 , 6 ]. Herein, we evaluate the predictive value of individual components of the R.E.N.A.L scoring system for Laparoscopic (LPN) and Robotic Partial Nephrectomy (RPN).…”
Background
To evaluate the predictive value of individual components of the R.E.N.A.L scoring system for Laparoscopic (LPN) and Robotic Partial Nephrectomy (RPN).
Methods
Patients that had undergone a Laparoscopic (LPN) or Robotic Partial Nephrectomy (RPN) between 2018 and 2023 were reviewed. Our data collection included Race, Ethnicity, Age, BMI, R.E.N.A.L nephrometry score, and complications. Cases that achieved trifecta outcomes were designated as “Group A” and cases that did not achieve trifecta were “Group B”. All the data were collected using REDCap database.
Results
A total of 111 cases were included, Group A consisted of 82% of all cases, whereas Group B 18%. Radius score demonstrated significant distinction concerning trifecta attainment and was the most predictive component of the 5 scoring metrics of the nephrometry system. In a subgroup analysis, R-score of 3 or a renal mass measuring ≥ 7 cm, was a significant independent negative predictor for trifecta outcomes, as well as tumor size at presentation.
Conclusion
Renal nephrometry score is predictive of trifecta outcomes for patients undergoing laparoscopic or robotic partial nephrectomy. Radius of mass was the most effective predictive component of the nephrometry score for trifecta prediction.
“…[ 4 16 20 22 ] Numerous studies have identified predictors of trifecta outcomes in relation to different surgical modalities and patient populations. Perioperative variables such as tumor size,[ 23 24 25 26 27 28 29 ] nephrometry scores (RNS,[ 27 30 31 ] PADUA score,[ 27 28 29 ] C-Index,[ 27 ] Simplified PADUA REnal [SPARE][ 32 ]), surgical approach,[ 23 33 ] pelvicalyceal system involvement,[ 23 ] hospital volume,[ 34 ] hilar location,[ 16 24 ] intraoperative blood loss,[ 24 28 35 ] and the American Society of Anesthesiologists grading[ 23 ] have been identified as independent predictors of the trifecta. However, apart from tumor complexity, none of the other factors have been consistently shown to predict these outcomes.…”
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