Factors Influencing the Operative Approach to Renal Tumors: Analyses According to RENAL Nephrometry Scores

Abstract

PurposeTo evaluate the relationship between RENAL nephrometry score (RNS) and operative approach for renal masses.Materials and MethodsThis study included 206 consecutive patients who underwent renal tumor surgery between January 2008 and October 2012. We divided the patients into four groups by surgical approach: open radical nephrectomy (ORN, 53 patients), laparoscopic radical nephrectomy (LRN, 83 patients), open partial nephrectomy (OPN, 31 patients), and laparoscopic partial nephrectomy (LPN, 39 patients). We retrospectively assessed the RNS for each surgery group and evaluated the relationship between this score and operative approach.ResultsThe mean RNSs of the ORN, LRN, OPN, and LPN groups were 9.75, 8.35, 6.72, and 5.76, respectively. When the RNS was analyzed according to nephron-sparing, the mean RNSs of the RN groups (ORN and LRN) and the PN groups (OPN and LPN) were significantly different (8.89 and 6.09, respectively; p<0.001). All the individual components of the RNS were significantly different between RN and PN. In the RN groups, the criteria for open versus laparoscopic surgery were based on tumor size ('R' score=2.43 for open, 1.54 for laparoscopic, p<0.001) and tumor location relative to the polar line ('L' score=2.55 for open, 2.09 for laparoscopic, p=0.006). In the PN groups, the criteria for open or laparoscopic surgery were based only on exophytic/endophytic property ('E' score=1.87 for open, 1.41 for laparoscopic, p=0.046).ConclusionsThe RNS was significantly different in all surgery groups. The decision to take a laparoscopic approach was primarily influenced by the R and L scores for RN and by the E score for PN.

The value of renal score in both determining surgical strategies and predicting complications for renal cell carcinoma: A systematic review and meta‐analysis

“…A full‐text review of the last 127 articles excluded those articles that could not obtain data and did not conform to the type of research. A total of 20 studies met the requirements of meta‐analysis …”

Nephrometry scoring system selects candidates for radical nephrectomy versus nephron sparing surgery for treatment of renal masses and predicts surgical and oncological outcome

“…Patients' number in Kutikov Naya et al 14 studied 142 patients and compared RENAL nephrometry score with the diameter-axial-polar nephrometry regarding the type of surgery for renal tumor, they didn't subdivide patients into complexity subgroups, they found that the mean RENAL nephrometry score in the radical group was higher than that in the NSS (9 vs. 7; with p <0.0001), which our study agrees with. 14 In 2013 Oh et al 12 In 2014, Cost et al 13 studied 65 patients, they classified renal masses into low, moderate and high complexity groups the same as in our study, two out of five of low score underwent radical nephrectomy, in contrast to our low score who all underwent NSS, while three out of 48 patients in the high complexity group of Cost et al 13 underwent NSS, in contrast to our high complexity group who all underwent radical nephrectomy. 13 Explanations for this are the difference between sample size and demographic characteristics and the different pathologies of the resected renal tumors, as 86.5% of the renal tumors in our study were renal cell carcinoma against only 16.4% in Cost's.…”

“…When the tumour is hilar "h" is added to the score giving it more complexity. RENAL system is subdivided according to complexity into low (4-6), moderate (7)(8)(9) and high (10)(11)(12).…”

“…nephrometry scoring preoperatively may be used as a guide to the complexity and choice of surgery for solid and cystic renal masses and for patient counselling, with reference to postoperative outcomes, Widespread use of this score may act as communication tools among specialists. [10][11][12][13]…”

The impact of non-hilar clamping open partial technique performed for the treatment of patients with small renal masses with lower R.E.N.A.L. nephrometry scores on renal functions during the early postoperative period

“…[25] In a retrospective study where among factors affecting preoperative approach in renal tumors, R.E.N.A.L nephrometry score was evaluated, R.E.N.A.L nephrometry scores were found to be significantly increased in patients who had undergone radical surgery. [26] In another study where predictive value of R.E.N.A.L nephrometry score was analyzed, a strong correlation was observed between R.E.N.A.L nephrometry score, and duration of warm ischemia. [27] Limited warm ischemia time is very well known to be associated with reversible impairment of renal functions.…”