Critical Appraisal of the PADUA Classification and Assessment of the R.E.N.A.L. Nephrometry Score in Patients Undergoing Partial Nephrectomy

Hew, Miki N.; Başeskioğlu, Barbaros; Barwari, Kurdo; Axwijk, P.H.; Can, Cavit; Horenblas, Simon; Bex, Axel; Rosette, Jean J.M.C.H. de la; Pes, M. Pilar Laguna

doi:10.1016/j.juro.2011.03.020

“…However, these data would suggest that further validation and refinement are needed prior to widespread acceptance. [4][5][6][7] The R.E.N.A.L. score was derived based on what the authors felt were important tumour characteristics rather than with statistical validation against an important outcome.…”

Section: Discussionmentioning

confidence: 99%

The association between renal tumour scoring systems and ischemia time during open partial nephrectomy

Lavallée¹,

Desantis²,

Kamal³

et al. 2012

CUAJ

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Preoperative patient characteristics (age, gender, preoperative renal function, diabetes, hypertension, smoking history, heart disease) and ischemia time were abstracted from medical records. Preoperative computed tomography (CT) images were reviewed and tumours were characterized using three scoring systems: (1) R.E.N.A.L. nephrometry score (radius, exophytic/endophytic properties, nearness of tumour to the collecting system or sinus in millimetres, anterior/posterior, location relative to polar lines); (2) preoperative aspects and dimensions used for anatomic (PADUA) classification; and (3) Centrality index (C index). Patients without preoperative CT and patients treated with laparoscopic partial nephrectomy were excluded. Results: During the study period, 78 patients met the inclusion criteria. Median R.E.N.A.L. score was 7 (interquartile range [IQR] 5-8), median PADUA score was 8 (IQR 7-10), and mean C index was 3.9 (standard deviation [SD] 2.1). Mean ischemia time was 23.4 (SD 10.8) minutes. Five individual tumour characteristics (diameter, nearness to collecting system, anterior/posterior location, medial/lateral location, and collecting system involvement) were strongly associated with ischemia time (p < 0.05). Increased R.E.N.A.L. score (1.5 minutes per unit 95%CI 0.08, 2.9, p = 0.04) and PADUA score (2.0 minutes per unit 95%CI 0.5, 3.5, p = 0.009) were significantly associated with ischemia time. An increasing C index score was also associated with ischemia time (-1.1 minutes per unit 95%CI -2.2, 0.04, p = 0.06), but the association was not statistically significant. Conclusion: Renal tumour characteristics are associated with ischemia time. The proposed scoring systems are useful descriptors of surgical complexity and should be used when describing partial nephrectomy patients. Prospective evaluation and refinement of scoring systems are required to create an optimized model prior to widespread application. IntroductionThe decision to perform radical versus partial nephrectomy for renal tumours is currently based on the subjective assessment of feasibility and patient preferences. Renal tumour scoring systems are designed to characterize tumours, facilitate cohort comparisons and allow for the prediction of surgical outcomes. Three scoring systems have been proposed and require validation: (1) R.E.N.A.L. nephrometry score (radius, exophytic/endophytic properties, nearness of tumour to the collecting system or sinus in millimeters, anterior/ posterior, location relative to polar lines); (2) preoperative aspects and dimensions used for anatomic (PADUA) classification; and (3) Centrality index (C index).1-3 The R.E.N.A.L. and PADUA systems categorize tumour characteristics and provide an overall score with a high score associated with more complex features. The C index method derives one number that reflects tumour size and distance from the centre of the kidney with a lower score representing tumours that are larger and closer to the kidney centre.Scoring systems are helpful if they are able to predict...

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“…All our procedures were performed obeying the same principle and our operative parameters were comparable to the published literature [6,7]. Recently few scoring systems have emerged to quantitate the tumor characterestics in a standardised pattern [8,9]. In our study we included the RENAL nephrometry score to de ine tumor pro ile and assessed the reproducibility of this scoring system.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic partial nephrectomy-does tumor profile influence the operative performance?

Das¹

2017

Arch Surg Clin Res

0

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Introduction: Laparoscopic approach is emerging as a standard of care approach for management of masses amenable to partial nephrectomy. Laparoscopic partial nephrectomy is a challenging surgery and its successful performance depends on various factors. We aim to evaluate the infl uence of tumor characterestics on the operative performance for laparoscopic partial nephrectomy. Methods:Patients undergoing laparoscopic partial nephrectomy in our institution were recruited for this study. The tumor profi le was evaluated by a senior radiologist from cross sectional imaging (computed tomography or magnetic resonance imaging). Tumor characerestics was defi ned by assessing tumor size, tumor location and RENAL score. The operative performance was evaluated in terms of warm ischemia time, blood loss, operation duration and any signifi cant operative complications. Statistical inference was drawn.Results: 37 patients who underwent laparoscopic partial nephrectomy between January 2010 and June 2012 were included in this study. The mean tumor dimension was 3.81 cms. 21 tumors involved left kidney and 16 involved right kidney. 12 were located in upper pole, 8 were located in midpole and 17 were located in lower pole. The average RENAL score was 6.56. The mean warm ischemia time, blood loss and operation duration was 26.29 minutes (min), 256.76 millilitres (ml) and 208.11 min respectively. Statistically signifi cant correlation was appreciated between tumor location (polar location, side, anterior/ posterior location) and RENAL score and operative parameters (warm ischemia time and operation duration). Tumor size did not have any correlation with the operative parameters. Conclusion:The operative performance of laparoscopic partial nephrectomy is signifi cantly infl uenced by the tumor location and RENAL score.

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“…or C Index scores were applied. 3,[6][7][8][9] To the best of our knowledge, this is the first study comparing all three scoring systems with ischemia time in patients undergoing open surgery. Other authors have stratified R.E.N.A.L.…”

Section: Discussionmentioning

confidence: 99%

“…The original publications and a small number of additional studies have examined some of these outcomes. [1][2][3][4][5][6][7][8][9] To the best of our knowledge, this is the first study applying all three scoring systems to a cohort of patients treated with open partial nephrectomy to determine which system is most predictive of ischemia time.We postulated that the individual components and overall scores of the R.E.N.A.L. (Table 1), PADUA and the C index systems are associated with surgical complexity/difficulty.…”

mentioning

confidence: 99%

The association between renal tumour scoring systems and ischemia time during open partial nephrectomy

Lavallée¹,

Desantis

²

,

Kamal

³

et al. 2013

CUAJ

View full text Add to dashboard Cite

Preoperative patient characteristics (age, gender, preoperative renal function, diabetes, hypertension, smoking history, heart disease) and ischemia time were abstracted from medical records. Preoperative computed tomography (CT) images were reviewed and tumours were characterized using three scoring systems: (1) R.E.N.A.L. nephrometry score (radius, exophytic/endophytic properties, nearness of tumour to the collecting system or sinus in millimetres, anterior/posterior, location relative to polar lines); (2) preoperative aspects and dimensions used for anatomic (PADUA) classification; and (3) Centrality index (C index). Patients without preoperative CT and patients treated with laparoscopic partial nephrectomy were excluded. Results: During the study period, 78 patients met the inclusion criteria. Median R.E.N.A.L. score was 7 (interquartile range [IQR] 5-8), median PADUA score was 8 (IQR 7-10), and mean C index was 3.9 (standard deviation [SD] 2.1). Mean ischemia time was 23.4 (SD 10.8) minutes. Five individual tumour characteristics (diameter, nearness to collecting system, anterior/posterior location, medial/lateral location, and collecting system involvement) were strongly associated with ischemia time (p < 0.05). Increased R.E.N.A.L. score (1.5 minutes per unit 95%CI 0.08, 2.9, p = 0.04) and PADUA score (2.0 minutes per unit 95%CI 0.5, 3.5, p = 0.009) were significantly associated with ischemia time. An increasing C index score was also associated with ischemia time (-1.1 minutes per unit 95%CI -2.2, 0.04, p = 0.06), but the association was not statistically significant. Conclusion: Renal tumour characteristics are associated with ischemia time. The proposed scoring systems are useful descriptors of surgical complexity and should be used when describing partial nephrectomy patients. Prospective evaluation and refinement of scoring systems are required to create an optimized model prior to widespread application. IntroductionThe decision to perform radical versus partial nephrectomy for renal tumours is currently based on the subjective assessment of feasibility and patient preferences. Renal tumour scoring systems are designed to characterize tumours, facilitate cohort comparisons and allow for the prediction of surgical outcomes. Three scoring systems have been proposed and require validation: (1) R.E.N.A.L. nephrometry score (radius, exophytic/endophytic properties, nearness of tumour to the collecting system or sinus in millimeters, anterior/ posterior, location relative to polar lines); (2) preoperative aspects and dimensions used for anatomic (PADUA) classification; and (3) Centrality index (C index).1-3 The R.E.N.A.L. and PADUA systems categorize tumour characteristics and provide an overall score with a high score associated with more complex features. The C index method derives one number that reflects tumour size and distance from the centre of the kidney with a lower score representing tumours that are larger and closer to the kidney centre.Scoring systems are helpful if they are able to predict...

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Critical Appraisal of the PADUA Classification and Assessment of the R.E.N.A.L. Nephrometry Score in Patients Undergoing Partial Nephrectomy

Cited by 134 publications

References 21 publications

The association between renal tumour scoring systems and ischemia time during open partial nephrectomy

The association between renal tumour scoring systems and ischemia time during open partial nephrectomy

Laparoscopic partial nephrectomy-does tumor profile influence the operative performance?

The association between renal tumour scoring systems and ischemia time during open partial nephrectomy

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