Modified R.E.N.A.L nephrometry score for predicting the outcome following partial nephrectomy

Abstract

Background It was difficult to compare the outcome of partial nephrectomy among different studies due to the absence of standardized description of different renal masses. This problem led to the development of nephrometry scoring systems. R.E.N.A.L. is among the commonest nephrometry scoring systems; however, some studies failed to find any relation between R.E.N.A.L. with perioperative outcome. We evaluated our designed newly modified nephrometry score in prediction of outcome following partial nephrectomy and compared its predictability versus original R.E.N.A.L. Methods Fifty-one patients with cT1-2N0M0 renal masses amenable for partial nephrectomy were included prospectively. Different perioperative outcome variables were compared according to complexity level in R.E.N.A.L. and the newly modified nephrometry score. Results Clinical staging was T1a (21.6%), T1b (49%), T2a (25.5%), T2b (3.9%). Median R.E.N.A.L. was 9 (4–12). Hilar position and intrarenal pelvis were detected in 19.6% and 68.6%. Low, moderate and high complexity masses were found in 21.6%, 39.2% and 39.2%. Complications and rate of conversion to radical nephrectomy were 17 (33.3%) and 4 (7.8%). The only significantly affected variable (p = 0.039) by R.E.N.A.L. was rate of secondary intervention, but it was higher in low than in high complexity level. In the newly modified nephrometry score, complications (p = 0.037) and rate of positive surgical margin (p = 0.049) were significantly higher with increased complexity level. Although other variables (pelvi-calyceal system entry, operative time, blood loss, hemoglobin loss, blood transfusion and conversion to radical nephrectomy) did not show statistically significant difference according to both scores, they were better associated with the complexity level in the newly modified nephrometry score with their remarkable increase in the high when compared to the low complexity level. Conclusions The newly modified nephrometry score was associated with better prediction of outcome of partial nephrectomy when compared to R.E.N.A.L.

Comparison of Perioperative Outcomes Between Laparoscopic and Open Partial Nephrectomy for Different Complexity Renal Cell Carcinoma Based on the R.E.N.A.L. Nephrometry Score

“… 29 , 31 A recent study by Salah M and co-workers indicated that a newly modified nephelometry score (MNS) was associated with better prediction of the outcome of partial nephrectomy when compared to R.E.N.A.L. 32 In future studies, the data will try to be further compared by using the newly modified nephelometry score.…”

Open and Laparoscopic Partial Nephrectomy: Comparison and Validation of Preoperative Scoring Systems, Including PADUA, RENAL, ABC Nephrometric Scores and Perinephric Fat Evaluation with Mayo Adhesive Probability Score

“…N.A.L. 25 Some other studies already suggest using simplified scores. Desantis et al suggest that a score incorporating tumour size and some measure of the tumour's depth/contact with the renal parenchyma can likely perform at least as well as RENAL or PADUA systems.…”

Outcomes of open partial nephrectomy for renal cell carcinoma in the minimally invasive approach era

“…[ 13 ] With regards to OPN surgery, Salah et al reported good renal function after OPN using brief warm ischemia or zero-ischemia. [ 14 ] In contrast, cold renal ischemia in OPN was considered to be acceptable for up to 2 hours. Nevertheless, it is preferable to keep cold ischemia time as short as possible.…”

“…Salah et al showed the relationship between the original NS and a modified NS for OPN. [ 14 ] They described the newly modified NS was better at predicting outcomes in OPN patients. In our series, we used both the original NS and modified NS, and showed risk factors for impaired renal function after OPN using both nephrometry models.…”

“…Recently, several studies showed that achievement of a “trifecta”, consisting of a warm ischemic time of <25 minutes, a negative surgical margin and no perioperative complications, should be a routine goal of minimally invasive surgery [13] . With regards to OPN surgery, Salah et al reported good renal function after OPN using brief warm ischemia or zero-ischemia [14] . In contrast, cold renal ischemia in OPN was considered to be acceptable for up to 2 hours.…”