RENAL nephrometry score predicts surgical outcomes of laparoscopic partial nephrectomy

Authors


Hyung L. Kim, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. e-mail: kimhl@cshs.org

Abstract

Study Type – Therapy (case series)

Level of Evidence 4

What’s known on the subject? and What does the study add?

For small renal tumours, partial nephrectomy provides excellent cancer control and preserves renal function. The RENAL Nephrometry Score is useful for quantifying anatomic features relevant to surgical decision-making.

In patients undergoing laparoscopic partial nephrectomy, this study shows a correlation between RENAL Nephrometry Score and estimated blood loss, warm ischemia time, and length of hospital stay, suggesting that the RENAL Nephrometry Score may be useful for predicting the technical challenge posed by a renal tumour.

OBJECTIVE

• To assess the use of the RENAL Nephrometry Score (RNS), which has been proposed as an anatomical classification system for renal masses, aiming to predict surgical outcomes for patients undergoing laparoscopic partial nephrectomy (LPN).

MATERIALS AND METHODS

• In the present study, 159 consecutive patients who underwent LPN were reviewed and RNS was calculated for 141 patients with solitary renal masses who had complete radiographic data.

• Renal tumours were categorized by RNS as low (nephrometry sum 4–6), intermediate (sum 7–9) and high (sum 10–12).

RESULTS

• Of the 141 patients, there were 43 (30%) low, 91 (65%) intermediate and seven (5%) high score lesions. There was no statistically significant difference in the demographics of the three groups.

• There was a significant difference in warm ischaemia time (16 vs 23 vs 31 min; P < 0.001), estimated blood loss (163 vs 312 vs 317 mL; P= 0.034) and length of hospital stay (1.2 vs 1.9 vs 2.3 days; P < 0.001) between the low, intermediate and high score groups, respectively. There was no difference in overall operative time (P= 0.862), transfusion rate (P= 0.665), complication rate (P= 0.419), preoperative creatinine clearance (P= 0.888) or postoperative creatinine clearance (P= 0.473) between the groups.

• Sixty-one lesions (43%) were anterior and 80 (57%) were posterior. No difference was found among any intra-operative, pathological or postoperative outcomes when comparing anterior vs posterior lesions.

CONCLUSIONS

• In patients undergoing LPN, a higher RNS was significantly associated with an increased estimated blood loss, warm ischaemia time and length of hospital stay.

• The RNS may stratify tumours based on the technical difficulty of performing LPN.

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