Preoperative scoring systems used in retroperitoneoscopic partial nephrectomy for T1-T2 renal tumors

Abstract

Introduction. P.A.D.U.A. (The preoperative aspects and dimensions used for anatomic), R.E.N.A.L. (radius exophytic/endophytic nearness anterior/posterior location) and zonal NePhRO scoring were developed in an effort to predict the intraoperative (warm time ischemia, blood loss) and postoperative complications in patients undergoing partial nephrectomy, with an important role on surgical decision-making (2-4). Materials and methods. Between January 2014 and July 2017, 37 patients(p) underwent retroperitoneoscopic nephro-sparing surgery at our center for clinically localized renal tumor. All patients had a normal contralateral kidney. The selection of patients for nephro-sparing surgery was based on preoperative CT scan, location of the tumor, the individual general health status of the patient and individual surgeon preferences. A chart review was carried out, including age, sex, anatomic preoperative scoring system (P.A.D.U.A., R.E.N.A.L. nephrometry and zonal NePhRO), operative time (skin opening to skin closing), estimated blood loss (EBL), warm ischemia time (WIT), hospital stay. Results. The mean age of patients with partial nephrectomy was 54.3±9.1 years. Mean preoperative serum creatinine level for the patient group was 0.97±0.14 mg/dl. All patients had normal contralateral kidney. Average tumor diameter in this group was 3.6± 0.86 cm. When using P.A.D.U.A. score to predict warm time ischemia p value was of 0.001, even if the mean warm ischemia time is higher in medium risk patients than in high risk patients 24.3 min vs. 23.2 min. R.E.N.A.L. nephrometry score was able to predict the warm ischemia time according to the risk groups (17.6 vs. 23.9 vs. 31 min) with a p value under 0.001. Zonal NePhRO score was statistically correlated with total operative time, blood loss, warm ischemia and renal function decrease, all with a p value < 0.05. Conclusion. P.A.D.U.A. score, R.E.N.A.L. nephrometry score and Zonal NePhRO score have proved to be reliable preoperative tools in order to evaluate surgical complexity and to predict outcomes such as warm time ischemia, blood loss, postoperative estimated GFR and complications rate.