You have accessJournal of UrologyKidney Cancer: Evaluation and Staging II1 Apr 2015MP44-15 ANATOMICAL SCORING SYSTEM FOR ASSESSING PARTIAL NEPHRECTOMY TECHNICAL COMPLEXITY Massimiliano Spaliviero, Bing Ying Poon, Christoph A. Karlo, Giuliano B. Guglielmetti, Pier Luigi Di Paolo, Felix Campos-Juanatey, Melanie L. Bernstein, Daniel D. Sjoberg, Paul Russo, Jonathan A. Coleman, Oguz Akin, and Karim A. Touijer Massimiliano SpalivieroMassimiliano Spaliviero More articles by this author , Bing Ying PoonBing Ying Poon More articles by this author , Christoph A. KarloChristoph A. Karlo More articles by this author , Giuliano B. GuglielmettiGiuliano B. Guglielmetti More articles by this author , Pier Luigi Di PaoloPier Luigi Di Paolo More articles by this author , Felix Campos-JuanateyFelix Campos-Juanatey More articles by this author , Melanie L. BernsteinMelanie L. Bernstein More articles by this author , Daniel D. SjobergDaniel D. Sjoberg More articles by this author , Paul RussoPaul Russo More articles by this author , Jonathan A. ColemanJonathan A. Coleman More articles by this author , Oguz AkinOguz Akin More articles by this author , and Karim A. TouijerKarim A. Touijer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1557AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We developed a surgical complexity score system based on the arterial vascular anatomy of the kidney in an attempt to overcome the limitations of available nephrometry scoring systems including inconsistent ability to predict clinical outcomes of partial nephrectomy. METHODS Contrast-enhanced computed tomography images of 179 patients who underwent partial nephrectomy were independently scored by 4 readers. According to the order of vessels involved by the tumor or needed to be transected during partial nephrectomy, assigned score was 1 for interlobular and arcuate arteries; 2 for interlobar arteries; 3S for segmental arteries; and 3H for renal hilum (Fig. 1). The Interobserver variability was assessed with kappa values and percentage of exact matches between each pairwise combination of the 4 readers. Spearman correlation was used to evaluate the association between scores of the most experienced reader (reference score) and ischemia time, estimated blood loss, incidence of urinary fistula within 30 days, and percent change in eGFR from baseline to 6 weeks and 6 months after surgery. RESULTS All pairwise comparisons of readers' score assignments were significantly correlated (all p <0.0001) with an average kappa of 0.545 across all reader pairs. The average proportion of exact matches was 69%. Spearman correlations between the complexity score system and surgical outcomes (Table 1) showed significant levels of correlation between the reference category assignments and ischemia time (p <0.0001, coefficient = 0.435), estimated blood loss (p = 0.008, coefficient = 0.198), and urinary fistula formation (p=0.008, coefficient of 0.196). CONCLUSIONS Similar to other nephrometry scoring systems, our anatomic system is associated with the surgical complexity and perioperative morbidity of partial nephrectomy. However, its intuitiveness and ease of learning is highly favorable compared to existing nephrometry systems. While these initial results are promising, further evaluation of our new scoring system and direct comparisons to the existing nephrometry are required. Category 1 (n = 13) Category 2 (n = 62) Category 3S (n = 69) Category 3H (n = 35) Estimated Blood Loss, mL, mean (95% CI) 169 (107, 232) 256 (195, 316) 285 (230, 339) 377 (253, 501) Ischemia Time, min, mean (95% CI) 17 (7, 25) 29 (26, 33) 39 (35, 42) 43 (37, 49) Urinary Fistula Formation, % (95% CI) 0 (0, 24.7) 3.2 (0.4, 11.2) 8.7 (3.3, 18.0) 17.1 (6.6, 33.6) % Change in postoperative eGFR by 6±4 weeks, n=100, % (95% CI) -3.6 (-15.2, 7.9) -5.2 (-9.6, -0.8) -7.6 (-12.1, -3.1) -0.3 (-17.6, 17.1) % Change in postoperative eGFR by 6±1 month, n=49, % (95% CI) -14.3 (-193.4, 164.8) -3.0 (-16.1, 10) -2.0 (-10.1, 6.1) -6.9 (-16.4, 2.6) © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e532 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Massimiliano Spaliviero More articles by this author Bing Ying Poon More articles by this author Christoph A. Karlo More articles by this author Giuliano B. Guglielmetti More articles by this author Pier Luigi Di Paolo More articles by this author Felix Campos-Juanatey More articles by this author Melanie L. Bernstein More articles by this author Daniel D. Sjoberg More articles by this author Paul Russo More articles by this author Jonathan A. Coleman More articles by this author Oguz Akin More articles by this author Karim A. Touijer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...