Abstract

BackgroundNephrometric scoring systems aim to improve the manner in which tumoral complexity is measured and reported. Each system provides a way to objectively measure specific tumor features that influence technical feasibility. In this study we aimed to determine how nephrometric scoring systems tailored our approach to the surgical treatment of localised renal masses.MethodsCharts of the patients with localised renal tumors, who were managed by either open or robot-assisted nephron-sparing surgery between May 2010 and June 2012, were retrospectively reviewed. Nephrometric scores [radius, exophytic/endophytic, nearness, anterior/posterior, location (R.E.N.A.L.) score, preoperative aspects and dimensions used for anatomic (P.A.D.U.A.) classification and centrality index (C-index)] were calculated based on preoperative imaging findings. Perioperative data were recorded. Morphometric characteristics of the renal masses were compared. Additionally, the difference between surgical alternative subgroups in terms of morphometric variables and the predictive power of each scoring system in determining the details of the surgical plan were investigated. Furthermore, surgical preferences in different nephrometric categories were compared.ResultsMean R.E.N.A.L. and P.A.D.U.A. scores of the tumors treated with robotic surgery were significantly lower than those managed by open surgery. R.E.N.A.L. nephrometry score showed significant differences between most of the surgical alternative subgroups. P.A.D.U.A. and C-index differences were significant only between robotic off-clamp and open clamped cases. Tumors that required open conversion had significantly higher mean R.E.N.A.L. and P.A.D.U.A. score. High R.E.N.A.L. score (cut-off: 6.5) and high P.A.D.U.A. score (cut-off: 7.5) were found to be significant predictors of the surgical route. Significantly more tumors with moderate R.E.N.A.L. score were managed through the open approach, while the significant majority of those with low R.E.N.A.L. and low P.A.D.U.A. score were operated by robotic assistance.ConclusionsR.E.N.A.L. and P.A.D.U.A. scores influenced our surgical treatment strategy for localized renal masses. High R.E.N.A.L. and P.A.D.U.A. scores increased the likelihood of an open NSS.

Highlights

  • Nephrometric scoring systems aim to improve the manner in which tumoral complexity is measured and reported

  • Considering the facts that, partial nephrectomy has similar oncologic outcomes to that of radical surgery for T1 tumors and renal insufficiency is associated with adverse cardiovascular outcomes, current evidence suggests that localised renal cancers are best managed by nephron-sparing surgery rather than by radical nephrectomy, whenever technically feasible [5]

  • Majority (72% in the robotic surgery group vs. 82.6% in the open surgery group, p = 0.52) of the tumors were discovered incidentally on imaging studies that were ordered for non-urologic complaints

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Summary

Introduction

Nephrometric scoring systems aim to improve the manner in which tumoral complexity is measured and reported. In this study we aimed to determine how nephrometric scoring systems tailored our approach to the surgical treatment of localised renal masses. Tumoral complexity remains the primary parameter according to which urologists determine the surgical approach and treatment strategy regarding renal masses. Technical details such as the route (open vs minimally invasive) and the decision to cease renal blood flow temporarily during mass excision (warm ischemia vs no ischemia) are under the influence of tumor characteristics. We aimed to determine how nephrometric scoring systems, tailored our approach in nephron-sparing surgery (NSS)

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