Development of a simple nomogram to estimate risk for intraoperative complications before partial nephrectomy based on the Mayo Adhesive Probability score combined with the RENAL nephrometry score

Abstract

Purpose This study aimed to develop a simple nomogram based on the Mayo Adhesive Probability (MAP) score combined with the RENAL nephrometry score (RNS) to predict intraoperative complications before partial nephrectomy (PN) in Asian populations. Materials and Methods This study retrospectively collected patients undergoing PN at three medical centers. Each component of the MAP score and the RNS (6 variables) was evaluated to assess its association with intraoperative complications by multivariable logistic regression with backward elimination. Results A total of 46 cases (7.2%) with intraoperative complications were identified among 637 patients. After backward elimination, three variables, including tumor diameter (4–7 cm vs. ≤4 cm: odds ratio [OR], 4.339; 95% confidence interval [CI], 1.943–9,692; ≥7 cm vs. ≤4 cm: OR, 8.434; 95% CI, 1.225–58.090), nearness to the collecting system (4–7 mm vs. ≥7 mm: OR, 2.988; 95% CI, 1.293–6.907; ≤4 mm vs. ≥7 mm: OR, 21.394; 95% CI, 6.122–74.756), and perirenal fat stranding type (type 1 vs. no stranding: OR, 3.119; 95% CI, 1.079–9.017; type 2 vs. no stranding: OR, 18.722; 95% CI, 6.757–51.868), were retained. The predictive power (measured by area under the curve [AUC]) of the nomogram was observed to be superior to the RNS or MAP score alone (RNS: 0.686, MAP score: 0.729, the nomogram: 0.837), but comparable to their combination (0.813). Conclusions The simple nomogram contains fewer components than the combination of the RNS and MAP scores yet demonstrates equivalent predictive power for intraoperative complications.

Predictive Value of the Mayo Adhesive Probability (MAP) Score in Laparoscopic Partial Nephrectomies: A Systematic Review from the EAU Section of Uro-Technology (ESUT)

“…The characteristics of the included studies are presented in Table 1. Eight studies (n = 8) were deemed eligible and were included in the final qualitative synthesis [16][17][18][19][20][21][22][23]. The included papers were critically appraised to assess the overall risk of bias by two investigators, using the Quality in Prognosis Studies (QUIPS) tool for non-randomized studies [24].…”

“…Supplementary Table S1 provides a detailed description of the risk of bias assessment of the included studies. In total, 2205 patients underwent PNs in the selected studies [16][17][18][19][20][21][22][23]. All the studies were retrospective [16][17][18][19][20][21][22][23].…”

“…In total, 2205 patients underwent PNs in the selected studies [16][17][18][19][20][21][22][23]. All the studies were retrospective [16][17][18][19][20][21][22][23]. Although none of the studies was a purely comparative one, six out of eight studies included two or more radiographic or nephrometry scores (one of which was the MAP score in all studies) and reported their association with outcomes [17][18][19][20][21][22].…”

“…All the studies were retrospective [16][17][18][19][20][21][22][23]. Although none of the studies was a purely comparative one, six out of eight studies included two or more radiographic or nephrometry scores (one of which was the MAP score in all studies) and reported their association with outcomes [17][18][19][20][21][22]. Two studies exclusively reported the association of the MAP with intraoperative and postoperative parameters [16,23].…”

“…Two studies exclusively reported the association of the MAP with intraoperative and postoperative parameters [16,23]. Most studies reported a retroperitoneal approach for laparoscopic PNs [19][20][21][22], while both transperitoneal and retroperitoneal laparoscopic PNs were reported in three studies [16,18,23]. The most frequently reported score in the comparison group was the RENAL nephrometry score (RNS) [17][18][19][20][21][22].…”