Renal tumour invasion index as a novel anatomical classification predicting urological complications after partial nephrectomy

Nísen, Harry; Ruutu, Mirja; Glücker, Esko; Visapää, Harri; Taari, Kimmo

doi:10.3109/21681805.2013.797491

Cited by 28 publications

(30 citation statements)

References 20 publications

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“…Other studies have examined the associations between scoring systems complications in partial nephrectomy and complications during open, laparoscopic, and robotic partial nephrectomy with similar findings. 12,18,[20][21][22][23][24] However, as has been previously suggested, our data suggest current systems can be improved. 25 One notable difference between this study and most others is the evaluation of individual scoring system components.…”

Section: Discussionsupporting

confidence: 64%

“…24,26 In the first study, the authors similarly evaluated all 3 scoring systems and found that a novel "RTII score" assessing tumour depth to parenchymal thickness ratio had better discrimination than RENAL or PADUA systems. 24 In the second study, the authors hypothesized tumour contact with the parenchyma would require more renal parenchymal resection, more transection of large blood vessels, and a more complex reconstruction. They devised a novel measure of tumour complexity incorporating similar components as the RTII score, namely the contact surface area (CSA), and found it associated with partial nephrectomy outcomes including complications.…”

Section: Discussionmentioning

confidence: 99%

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The association between renal tumour scoring system components and complications of partial nephrectomy

Desantis

Lavallée

Witiuk

et al. 2015

CUAJ

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Introduction: We evaluate the associations between 3 renal tumour scoring systems and their components with perioperative complications of partial nephrectomy. Methods: A consecutive cohort of partial nephrectomy patients was analyzed. Patient characteristics were abstracted from medical records. PADUA scores (preoperative aspects and dimensions used for anatomic classification), RENAL (radius exophyic/endophytic nearness anterior/posterior location scoring) nephrometry scores, and Centrality index (C-index) were determined from preoperative axial images by 2 independent reviewers. Cases were evaluated for postoperative complications up to 30 days after surgery. Pre-specified complication definitions were used for 33 potential medical and surgical complications. Unadjusted and adjusted associations between overall scores, individual components, and complications were determined using log binomial regression. Results: In total, 118 patients were included in the study. Of these, 36 (30.5%) surgical complications occurred in 27 (22.9%) patients. Fourteen (11.9%) were Clavien grade ≥3. Overall PADUA score was significantly associated with surgical and overall complications after adjusting for potential confounders. Among all components of the 3 scoring systems, only tumour diameter and exophytic/ endophytic nature of the tumour were significantly associated with complications after adjusting for the other components of the respective scoring system (p < 0.05). Conclusions: Renal tumour scoring systems may help predict the risk of complications after partial nephrectomy. Further refinement of current systems is required. A first step would be to include only components that are significantly associated with complications.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

The association between renal tumour scoring system components and complications of partial nephrectomy

Desantis

Lavallée

Witiuk

et al. 2015

CUAJ

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“…The depth of tumor invasion has been well identified as an important variable that affects the facility of partial nephrectomy and the perioperative complication rate. 8,9,23 Some groups have noticed that the depth of the tumor affects the surgery decision-making process. 23 Tannus and colleagues 8 showed that the chance of a patient undergoing radical nephrectomy was 34 times greater in a patient with a tumor that extended beyond the renal medulla.…”

Section: Discussionmentioning

confidence: 99%

“…Since 2009, eight distinct objective anatomic classification systems of renal tumors, such as radius exophyic/endophytic nearness anterior/posterior location (R.E.N.A.L. ), 3 preoperative aspects and dimensions used for an anatomical (PADUA) classification, 4 C-Index, 5 Diameter-AxialPolar, 6 NePhRO (nearness to collecting system, physical location of the tumor in the kidney, radius of the tumor, and organization of the tumor), 7 surgical approach renal ranking, 8 Renal Tumor Invasion Index, 9 and zhongshan score, 10 have been proposed, aiming to standardize the description of renal tumors. Recent efforts have focused on the preservation of renal parenchyma and reduction of ischemia time to preserve renal function.…”

mentioning

confidence: 99%

Number of Renal Columns Invaded by Tumor: A Novel Parameter for Predicting Complexity and Outcomes of Off-Clamp Open Partial Nephrectomy

Zhou

Cao

Bian

et al. 2015

Journal of the American College of Surgeons

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“…There has been a proliferation of renal scoring systems, with the PADUA scoring system, RENAL scoring system, Centrality index (C-index), [1][2][3] and recently the RTII score, 4 and the CSA (contact surface area) score. 5 These scoring systems attempt to objectively quantify the complexity of renal tumours in preparation for surgery.…”

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confidence: 99%

Renal tumour scoring systems: How useful are they?

Kapoor¹

2015

CUAJ

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Partial nephrectomy for renal tumours is a challenging surgical operation, whether performed through the traditional open surgical route, or approached laparoscopically or robotically. Any operation where there is an ablative component, with a reconstructive component, within the confines of renal ischemia with the clock ticking ("every minute counts"), can challenge any urologic surgeon's skills. There is the risk for perioperative bleeding, blood transfusion, and renal ischemia with prolonged renal hilar clamping. Postoperatively, there are risks of renal pseudo-aneurysm, peri-nephric hematoma, urine leak, kidney non-function from prolonged ischemia, residual tumour from incomplete excision, and perioperative medical morbidity.Any tools to minimize the risk of intra-operative and postoperative complications from partial nephrectomy are welcome. There has been a proliferation of renal scoring systems, with the PADUA scoring system, RENAL scoring system, Centrality index (C-index), [1][2][3] and recently the RTII score, 4 and the CSA (contact surface area) score. 5 These scoring systems attempt to objectively quantify the complexity of renal tumours in preparation for surgery. But which scoring system is better and how useful are they to the urologic surgeon?Desantis, and colleagues 6 in this issue of CUAJ tackle a comparison of the three most common renal tumour scoring systems by comparing the PADUA, RENAL and C-Index scores in a cohort of patients undergoing partial nephrectomy and correlate with postoperative complications. They have found that tumour size and tumour depth within the kidney are more predictive of complications than other components of these scoring systems. Further, polar versus mid-kidney location of the tumour appear to have an inverse relationship to perioperative complications. Put together, this data would suggest that these current scoring systems are imperfect, and further work needs to be done to optimize their usefulness. Newer scoring systems, such as the RTII score, assess tumour depth to parenchymal thickness ratio, and the CSA score, assess tumour contact with normal parenchyma, and may be more predictive of renal surgery complexity. Of course, more study and validation is required for these newer scoring systems.Practically, how many of us use a renal scoring system before surgery? How many of us use a "renal score" in discussion with patients? Most of us "eye-ball" the tumour and give an educated and experienced opinion on the potential complexity and difficulty of surgery. As renal scoring systems are fine-tuned, for now we can rely on the size and depth of the tumour (endophytic component) as objective measures of the complexity of surgery.Competing interests: Dr. Kapoor is a member of the Speakers bureau for, and has received grants and honoraria from, Pfizer Oncology, GSK Oncology, Novartis Oncology and Amgen. He has also participated in clinical trials within the past 2 years with NCIC, Pfizer, GSK, Novartis and Amgen. This paper has been peer-reviewed.

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Renal tumour invasion index as a novel anatomical classification predicting urological complications after partial nephrectomy

Abstract: RTII is as good as the previous more complicated ACSs in predicting urological complications after partial nephrectomy. As a simple measurement with a straightforward anatomical interpretation, RTII may be useful in counselling patients and stratifying patients in studies.

Cited by 28 publications

References 20 publications

The association between renal tumour scoring system components and complications of partial nephrectomy

The association between renal tumour scoring system components and complications of partial nephrectomy

Number of Renal Columns Invaded by Tumor: A Novel Parameter for Predicting Complexity and Outcomes of Off-Clamp Open Partial Nephrectomy

Renal tumour scoring systems: How useful are they?

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