The Nephrometry Score: Is It Effective for Predicting Perioperative Outcome During Robot-Assisted Partial Nephrectomy?

Abstract

PurposeRobot-assisted partial nephrectomy (RPN) has emerged as an alternative treatment for the management of small renal masses. This study was designed to investigate parameters that predict perioperative outcomes during RPN.Materials and MethodsWe retrospectively reviewed the medical records of 113 patients who underwent RPN between September 2008 and May 2012 at the Seoul National University Bundang Hospital. Clinical parameters, including warm ischemia time (WIT), estimated blood loss (EBL), and R.E.N.A.L and PADUA scores, were evaluated to predict perioperative outcomes.ResultsOf the 113 patients, 81 were men and 32 were women. The patients' mean age was 53.5 years, and their mean body mass index was 22.3 kg/m2. Age, gender, and mass laterality had no effect on perioperative complications, WIT, or EBL. Univariate analysis revealed that a distance between the tumor and the collecting system of ≤4 mm or a renal mass size of >4 cm were associated with adverse profiles of complications, WIT, and EBL. However, multivariate analysis showed no association between the predictive parameters and tumor complexity as assessed by nephrometry scores. Tumor size of >4 cm increased the risk of blood loss >300 mL (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.3.9.7; p=0.016). A distance between the tumor and the collecting system of ≤4 mm was associated with increased risk of WIT exceeding 20 minutes (OR, 2.8; 95% CI, 1.3.6.3; p=0.012).ConclusionsTumor size and proximity of the mass to the collecting system showed significant associations with EBL and WIT, respectively, during RPN. The R.E.N.A.L and PADUA nephrometry scoring systems did not predict perioperative outcomes.

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

“…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.…”

Comparison of RENAL, PADUA, and C-index scoring systems in predicting perioperative outcomes after nephron sparing surgery

“…There have been conflicting reports showing the superiority of one score over the other. [ 4 7 8 ] In an earlier study, we found that mean tumor size and staging in our series was advanced as compared to that in available literature. [ 9 ] We designed this study to evaluate the predictive value of SS (RENAL, PADUA score, and C-index) in determining perioperative outcome in NSS and to determine interobserver reliability, reproducibility, and variation in scoring done by urologist versus radiologist.…”

“…However, the predictive value of these SS in predicting the perioperative outcomes is still controversial. [ 4 7 8 ] In fact, with the advent of robotic surgery more and more data have been compiled recently with NSS being offered to patients with larger tumors or highly complex tumors. [ 12 13 ]…”

Evaluation von Padua- und R.E.N.A.L.-Score hinsichtlich ihrer Aussagekraft und Implikationen auf das perioperative Management bei der partiellen Nephrektomie

“…Zu den methodischen Aspekten dieser Arbeit ist weiterhin zu erwähnen, dass die Interobserver-Variabilität für die Erstellung des Padua-und R.E.N.A.L.-Scores als von der klinischen Erfahrung abhängig charakterisiert werden konnte [12]. Die Roboter-assistierte partielle Nephrektomie, die als Operationstechnik bei fast allen (> 97 %), in diese Untersuchung eingeschlossenen Patienten zum Einsatz kam, als zunehmend häufig verwendete Methode, findet sich auch in vielen anderen Studien als hauptsächlich verwendete OP-Technik wieder [5,13]. Hier wird die rasche Entwicklung der Nierenchirurgie in den letzten Jahren besonders deutlich.…”

“…Dies allerdings bei einem ebenfalls relativ kleinen Patientenkollektiv (N = 113) und im Gegensatz zu unserer Arbeit unter Ausschluss aller Patienten, bei denen eine radikale Nephrektomie notwendig wurde, was sicherlich zu einer Verzerrung der Outcome-Parameter des Patientenkollektivs führen kann. Außerdem stellt sich die Frage, ob die Operationalisierung der Komplikationen lediglich über die Ischämie-Zeit und den geschätzten Blutverlust, wie hier geschehen, zu einer ausreichenden klinischen Relevanz führt [5].…”