Application of a standardized anatomical classification in a Chinese partial nephrectomy series

Abstract

Preoperative aspects and dimensions used for an anatomical classification is a standardized system to assess the anatomical complexity of renal tumors and its impact on perioperative outcomes of partial nephrectomy. The objective is to apply the preoperative aspects and dimensions used for an anatomical classification in a series of Chinese patients undergoing open or laparoscopic partial nephrectomy. A total of 195 consecutive renal tumors treated with open partial nephrectomy or laparoscopic partial nephrectomy between June 2008 and May 2011 were included in this analysis. All the preoperative images and clinical records were retrospectively evaluated. Complication rate, warm ischemia time, operation time and degree of blood loss were compared among different risk groups (low risk: preoperative aspects and dimensions used for an anatomical score 6-7; intermediate risk: preoperative aspects and dimensions used for an anatomical score 8-9; high risk: preoperative aspects and dimensions used for an anatomical score ≥10). The original preoperative aspects and dimensions used for an anatomical score system was modified by replacing rim location with hilar vasculature involvement and tested for prediction of overall complications. The median preoperative aspects and dimensions used for an anatomical score was 8. Overall complication rate was 17.9%. Preoperative aspects and dimensions used for an anatomical score was an independent predictor for perioperative complications. Intermediate and high-risk patients had a four- and 37-fold higher risk of complications respectively (P = 0.012, P < 0.001). Higher preoperative aspects and dimensions used for an anatomical score predicted longer operation time (P = 0.007), warm ischemia time (P < 0.001) and higher degree of blood loss (P = 0.003) in open partial nephrectomy patients. In laparoscopic partial nephrectomy patients, preoperative aspects and dimensions used for an anatomical score was also a predictor for warm ischemia time (P = 0.033); however, it was not significant for operation time and degree of blood loss (P = 0.325, P = 0.302). The modified preoperative aspects and dimensions used for an anatomical score was an independent predictor for overall complications (P < 0.001); however, its superiority could not be verified (P = 0.847). The preoperative aspects and dimensions used for an anatomical classification predicts the risk of overall complications in Chinese patients undergoing nephron-sparing surgery. Replacing the rim location with hilar vasculature involvement might be a promising modification of this scoring system.