Comparison of diameter‐axial‐polar nephrometry score and RENAL nephrometry score for surgical outcomes following laparoscopic partial nephrectomy

Yoshida, Kenji; Kinoshita, Hidefumi; Yoshida, Takashi; Takayasu, Kenta; Mishima, Takao; Yanishi, Masaaki; Komai, Yoshihiro; Sugi, Motohiko; Kawa, Gen; Matsuda, Tadashi

doi:10.1111/iju.13009

Cited by 9 publications

(3 citation statements)

References 21 publications

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“…Yoshida et al, 15 compared DAP and RENAL score for prediction of surgical outcomes of LPN. DAP was found to be a better overall predictor of surgical outcomes than the RENAL score.…”

Section: Discussionmentioning

confidence: 99%

A comparison of DAP and RENAL scoring systems in the achievement of trifecta in laparoscopic partial nephrectomy

et al. 2021

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Purpose: The concept of ‘trifecta’ outcome postulated for radical prostatectomy has been adopted for partial nephrectomy, the gold standard for management of small renal masses. We sought to evaluate the role of nephrometry scores in predicting outcomes in terms of the trifecta. We compared two scoring systems for renal tumour complexity (RENAL and DAP) in the prediction of trifecta outcomes. Materials and methods: Sixty-nine patients who underwent laparoscopic PN (LPN) were evaluated in a single-centre retrospective study (2010–2017). RENAL and DAP scores were measured. Parameters relevant to the trifecta were tabulated. Results: When comparing the two scoring systems in terms of warm ischaemia time (WIT), the DAP score could predict with statistically significant accuracy the completion of resection within 25 mins of WIT. Tumours were more evenly distributed according to anatomical characteristics with the DAP scoring system than with the RENAL scoring system. When comparing these systems in terms of complications, neither predicted complications based on complexity with significant accuracy. A low RENAL score predicted trifecta achievement in three-fourth (71.4%) of patients, while a medium RENAL score predicted trifecta achievement in half (54%) of patients. DAP score predicted trifecta achievement in all tumours with a low score, two-third (66%) in medium and less than half (42%) with a high score. Predictions based on DAP were accurate and significantly so ( p = 0.024). Conclusions: DAP score predicted the outcomes of LPN in terms of trifecta significantly better than the RENAL score. In our experience, the DAP score was able to distribute tumour complexity among its groups more effectively than the RENAL score. There is early evidence that the DAP score may be more useful than the RENAL score for decision-making in nephron sparing surgery. This is especially pertinent for small renal masses at the upper limits of tumour complexity for which minimally invasive techniques can be safely applied.

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“…Yoshida et al, 15 compared DAP and RENAL score for prediction of surgical outcomes of LPN. DAP was found to be a better overall predictor of surgical outcomes than the RENAL score.…”

Section: Discussionmentioning

confidence: 99%

A comparison of DAP and RENAL scoring systems in the achievement of trifecta in laparoscopic partial nephrectomy

et al. 2021

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“…In another study, RENAL and DAP were compared for laparoscopic partial nephrectomy, and DAP was found to be better correlated than RENAL with warm ischemic time and estimated blood loss. 30 Because the SPARE score is a novel score that is well accepted, we hypothesized that it may perform better than PADUA and RENAL. However, one study showed that SPARE had no signi cant advantage for predicting EBL and ischemia time outcomes in PN over the other two classic scores 20 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of the RENAL, PADUA, DAP, NePhRO, and SPARE scores for retroperitoneal laparoscopic partial nephrectomy.

Jin¹,

Wang²,

Yang³

et al. 2020

Preprint

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Background: Nephrometry scores play a critical role in the preoperative evaluation of partial nephrectomy. Although score comparisons have been performed for transperitoneal or open surgery, systematic comparisons for retroperitoneal operations are lacking.Methods: We retrospectively evaluated the clinical records of patients who underwent partial nephrectomy at one center by one surgeon. Scores were generated according to the imaging results, and each score was categorized into low-, intermediate- and high-complexity groups. Then, the differences in perioperative outcomes were compared among the groups. We assessed whether the scores and sex, body mass index (BMI), age, or American Society of Anesthesiologists (ASA) Physical Status classification could predict whether the warm ischemia time (WIT) was likely be longer than 20 min and whether they could predict postoperative complications worse than Clavien–Dindo 1. The interobserver variability between two experienced surgeons for these scores was calculated with the intraclass correlation coefficient (ICC).Results: A total of 107 patients were ultimately evaluated. The median tumor size was 36.88 mm, and the median WIT, total operation time (OT) and estimated blood loss (EBL) were 18.97 min, 80 min, and 100 ml, respectively. Significant differences in WIT were identified among the complexity groups for each scoring system. Significant differences were identified between the OTs associated with the DAP and RENAL score complexity groups. The scores included in this study were significantly associated with the probability of having a WIT >20 min and high-grade postoperative complications. Receiver Characteristic Operator (ROC) curves showed that there were no significant differences in their predictive power. NePhRo had the highest agreement (0.839), followed by DAP (0.827). RENAL was superior to SPARE and PADUA, which were 0.758, 0.724 and 0.667, respectively.Conclusions: The scores included in this study were useful for preoperative assessment of retroperitoneal laparoscopic partial nephrectomy. No significant differences were observed among the scores in terms of their ability to predict prolonged hot ischemia time or high-grade postoperative complications. DAP is a good score in the retroperitoneal circumstance when its consistency is taken into account.

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“…Correlations with WIT, ORT, and percent change in eGFR [21,23,25] Predict the perioperative and postoperative complications; indicate ischemia time [22,25] Predict collecting system entry [23] Associated with the type of surgical approach (open vs. laparoscopic/robotic) and urine leak [24] PADUA Correlated with WIT, ORT, blood loss, and UCS repair [25] Independent predictors of WIT and overall complications [25,27] Predict the perioperative and postoperative complications; indicate ischemia time [22,25,27] Centrality index score Correlations between complexity categories and WIT, ORT, and EBL [21] Associated with WIT [21] Diameter-axial-polar score Estimate the complexity of tumor characteristics better than the RENAL score [29] Associated with kidney volume preservation [31] ABC Associated with EBL, warm and cold ischemia time, and urinary fistula [30] WIT, warm ischemia time; ORT, operation time; eGFR, estimated glomerular filtration rate; EBL, estimated blood loss; UCS, urinary collecting system.…”

Section: Renal Nephrometrymentioning

confidence: 99%

Laparoscopic and Robotic-Assisted Partial Nephrectomy: An Overview of Hot Issues

Cheng

Zhang

et al. 2020

Urol Int

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Laparoscopic partial nephrectomy and robot-assisted partial nephrectomy are attracting increased attention from urologists. They can achieve the same effect of oncology control as radical nephrectomy; moreover, they can offer better preservation of renal function, thus obtaining longterm living benefits. The indications are also expanding, making it possible for larger and more difficult tumors. Laparoscopic partial nephrectomy and robot-assisted partial nephrectomy can be performed by transperitoneal and retroperitoneal approaches, with their individual advantages and limitations. In addition, the renal tumor scoring systems have been widely used and studied in laparoscopic partial nephrectomy and robot-assisted partial nephrectomy. In order to better preserve renal function, the zero-ischemia technique is widely used. The application of intraoperative imaging technology provides convenience and greater benefits. Besides, whether minimal invasive partial nephrectomy can be performed without stop antiplatelet treatment is still disputed. Clinicians perform substantial exploration and practice to achieve the "trifecta" of surgery: complete resection of the tumor, maximum protection of renal function, and no complications.

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Comparison of diameter‐axial‐polar nephrometry score and RENAL nephrometry score for surgical outcomes following laparoscopic partial nephrectomy

Cited by 9 publications

References 21 publications

A comparison of DAP and RENAL scoring systems in the achievement of trifecta in laparoscopic partial nephrectomy

A comparison of DAP and RENAL scoring systems in the achievement of trifecta in laparoscopic partial nephrectomy

Comparison of the RENAL, PADUA, DAP, NePhRO, and SPARE scores for retroperitoneal laparoscopic partial nephrectomy.

Laparoscopic and Robotic-Assisted Partial Nephrectomy: An Overview of Hot Issues

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