How can the R.E.N.A.L. nephrometry scoring system aid management of a solid renal mass?

Abstract

OBJECTIVES. To investigate use of the R.E.N.A.L. nephrometry score in relation to the choice of treatment and postoperative complications for renal masses. DESIGN. Case series. SETTING. A tertiary referral hospital in Hong Kong. PATIENTS. Data of patients undergoing nephrectomy were collected retrospectively from a clinical database and analysed. A R.E.N.A.L. nephrometry score was allocated to each renal tumour by a blinded qualified radiologist, utilising computerised imaging systems. Patient demographics, choice of surgery (radical vs partial), and approaches (open vs minimally invasive) were analysed with respect to their R.E.N.A.L. score. RESULTS. In all, 74 patients were included during the study period, of which 38 underwent partial nephrectomy and 36 underwent radical nephrectomy. No differences between the groups were found with respect to patient demographics. There were significant differences between the partial and radical nephrectomy groups in terms of their mean nephrometry score (6.9 vs 9.3, P<0.001). The mean nephrometry sum was also significantly different in the open approach versus the minimally invasive approach in patients having partial nephrectomy (7.8 vs 6.0, P=0.001). There was no difference in the postoperative 90-day morbidity and mortality in the partial nephrectomy and radical nephrectomy groups. CONCLUSIONS. The R.E.N.A.L. nephrometry score of a renal mass correlated significantly with our choice of surgery (partial vs radical) and our approach to surgery (open vs minimally invasive surgery), particularly in the partial nephrectomy group. It does not, however, correlate with postoperative complications. The nephrometry score provides a useful tool for objectively describing renal mass characteristics and enhancing better communication for the operative planning directed at renal masses.

R.E.N.A.L. Nephrometry Score Profile of Kidney Cancer Patients in Cipto Mangunkusumo Hospital

“…In our present study, from 52 patients that were treated with radical nephrectomy, 29 patients were categorized as high complexity tumor (100% of total) and 23 were categorized as moderate complexity tumor (80% in total), and none were categorized as low complexity tumor. This data correlates well with the study conducted by Canter et al [14] and Wong et al [6] which showed that patients treated with radical nephrectomy were of moderate and high complexity;…”

“…It was different from the radical nephrectomy group where there were no patients categorized as low complexity tumor. This profile correlates well with Canter et al [14] study and Wong et al [6] study. From both of those studies, it was shown that patients with low complexity tumor and some of the moderate complexity tumors were being treated with nephronsparing surgery/partial nephrectomy [6,14].…”

“…This profile correlates well with Canter et al [14] study and Wong et al [6] study. From both of those studies, it was shown that patients with low complexity tumor and some of the moderate complexity tumors were being treated with nephronsparing surgery/partial nephrectomy [6,14]. Overall, with higher complexity, it is more likely for the tumor to be treated with radical nephrectomy [14].…”

“…xophytic/endophytic subscales that explains the exo/endophytic properties of tumor, (N) subscales that is defined as nearness of tumor to collecting system or sinus, (A)nterior/posterior subscale with a as descriptor for anterior location, p as descriptor for posterior location, and x as descriptor for neither anterior nor posterior (could not be defined), and (L) ocation of tumor relative to the polar line. Suffix "h" or hilar is assigned for a tumor that is close or touches the main renal artery or vein [1][2][3][4][5][6][7]11,[14][15][16][17]. R.E.N.A.L.-NS could be scored based on CT or MRI findings of patients at diagnosis [1].…”

“…Kidney cancer is one of the most common forms of cancer in Indonesia, ranked third of all urogenital tumors with an incidence of 2,093 per 100,000 population and was estimated to have 5-years prevalence of 4,444 per 100,000 population in 2012 [1][2][3][4][5][6]. Renal cell carcinoma (RCC) comprises approximately 90% of all malignant renal tumors [1].…”