Functional outcome prediction after partial nephrectomy using R.E.N.A.L. nephrometry, PADUA classification, and Centrality index score

Abstract

ObjectiveSeveral scoring systems have been proposed to quantify surgical complexity, and provide an insight into expected peri- and postoperative surgical outcomes following partial nephrectomy. However, it is still unclear which of the scoring systems has a better outcome in predicting functional outcomes after partial nephrectomy. In the present study, we assess the use of R.E.N.A.L. (Radius, Exophytic/endophytic properties of the tumor, Nearness of tumor deepest portion to the collecting system or sinus, Anterior/posterior descriptor and Location relative to the polar line.), PADUA (preoperative aspects and dimensions used for an anatomical score), and centrality index scores to predict the renal function for patients who underwent partial nephrectomy. Materials and methodsWe retrospectively reviewed 26 cases with renal tumors managed with open partial nephrectomy at our institution from January 2008 to October 2013. R.E.N.A.L., PADUA, and centrality index scores were assigned according to the described protocols for those systems. We evaluated the association between scoring systems and both early and late postoperative functional outcomes. ResultsThe mean age of the study population was 56 years. Of the patients, 18 (69%) were men. The mean tumor size was 4.04 cm. Each scoring system performed significant correlation with both early and late functional outcomes (p < 0.05), whereas R.E.N.A.L nephrometry and PADUA classification showed high correlation (−0.715 and −0.721) and centrality index showed moderate correlation (0.451). Diameter of tumors, as a single anatomical parameter, does not correlate with functional outcome significantly (p = 0.974 1 day after surgery and p = 0.865 1 year after surgery). ConclusionR.E.N.A.L., PADUA, and centrality index scores were inversely associated with renal function preservation after partial nephrectomy. In this regard it is possible to use these scoring systems preoperatively to gauge the magnitude of functional decrease.