Predicting outcomes in partial nephrectomy: is the renal score useful?

Matos, Ana Catarina; Oglio, Marcos Francisco Dall; Colombo, José R.; Crippa, Alexandre; Juveniz, João Alexandre Queiroz; Argôlo, Felipe Coelho

doi:10.1590/s1677-5538.ibju.2016.0315

Cited by 11 publications

(13 citation statements)

References 29 publications

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“…This was in the range of reported complications in other studies (24.24-38.46%) [2,13,[23][24][25][26]. We had 4 cases (7.8%) of conversion to RN which was similar to that found in different studies (6-16.3%) [17,27,28].…”

Section: Discussionsupporting

confidence: 89%

“…Accordingly, the new score is ranging from 5 to 23. It is classified into mild complexity (5)(6)(7)(8)(9), moderate complexity (10)(11)(12)(13)(14) or high complexity (15)(16)(17)(18)(19)(20)(21)(22)(23). A renal mass can be described using the MNS as (R + E + N + ap x + L + H + RPS).…”

Section: Newly Modified Nephrometry Score (Mns)mentioning

confidence: 99%

“…However, some studies failed to find any relation between R.E.N.A.L. with operative parameters or postoperative outcome [13][14][15][16][17][18]. Thus, the need for continuous improvement in these NS is obvious for better prediction of the outcome and proper selection of the surgical technique.…”

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confidence: 99%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 89%

Section: Newly Modified Nephrometry Score (Mns)mentioning

confidence: 99%

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

et al. 2020

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“…Some studies showed comparable PSM rates for central and peripheral tumors [51], others a higher risk for central located tumors [52,53]. In the last years, some studies stratified PSM rates according to the risk categories defined by nephrometry scores [8,16,34]. No study demonstrated a significant impact of nephrometry score on risk of PSMs.…”

Section: Discussionmentioning

confidence: 99%

Positive Surgical Margins After Partial Nephrectomy: A Systematic Review and Meta-Analysis of Comparative Studies

Ficarra

Crestani

Inferrera

et al. 2018

KCA

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Objective: We performed an update of previous reviews of the literature to provide an overview on incidence, predictive factors, management and prognosis of positive surgical margins (PSMs) after partial nephrectomy (PN) including recent surgical series and studies comparing different approaches and techniques. Material and methods: A literature search was performed from January 2013 to January 2018 using the Medline database. The search strategy included a free-text protocol using the term "nephron-sparing surgery" OR "partial nephrectomy" AND "positive surgical margins" across the title and abstract fields of the records. From each selected study, we extracted the following data: number of analyzed patients, study design, approach and surgical technique used, PSMs rate, pathological features, type of PSMs treatment, mean (median) follow-up duration and final patient status. Meta-analysis was conducted using Review Manager software v. 5.2 (Cochrane Collaboration, Oxford, UK). Results: We selected a total of 36 (48%) studies. All studies were retrospective and the best statistical method used for comparison was the matched-pair analysis (level 4). Overall, 45,786 patients treated with PN were included in the selected studies. PSMs were reported in a total of 3,093 (6.7%) patients. The mean estimated PSMs rate was 7%, 5% and 4.3% in patients who underwent robot-assisted PN (RAPN), laparoscopic PN (LPN) and open PN (OPN), respectively. Comparative studies showed a significant advantage in favor of OPN compared with minimally invasive approach, while RAPN showed more favourable PSMs risk compared with LPN (odds ratio 3.02, 95% confidence intervals 2.05-4.45). No differences were detected stratifying data according to other surgical or tumor-related factors. Tumor size, nuclear grading and pT3a stage represent the most important predictors of PSMs. In 6,809 patients, follow-up data were available. Only 101 (1.4%) local recurrences and 88 (1.3%) distant recurrences were observed both in PSMs and negative surgical margins subgroups. PSMs were associated with a significant increased risk of local recurrence with a significant impact on local recurrence-free survival and metastasis-free survival. However, a significant impact on cancer-specific and overall survival could not be demonstrated.

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“…[ 5 ] A prospective study performed by Matos et al ., which included 71 patients, showed that the RNS was a good method in predicting surgical access route and type of nephrectomy, and the RNS was also associated with OT and WIT, but with weak accuracy. [ 20 ] Kriegmair et al . conducted a systemic comparison of the aforementioned nephrometry scoring systems and concluded that all scoring systems represent objective and reproducible measurement tools for renal tumor complexity, and that the RENAL, PADUA, and NePhRO scores are comparable and seem to be more superior to C-index.…”

Section: Discussionmentioning

confidence: 99%

Role of R.E.N.A.L. Nephrometry Score in Laparoscopic Partial Nephrectomy

Zhou

Yan

Zhang

et al. 2017

Chinese Medical Journal

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Background:Preoperative anatomical scoring system is conducive to comparison between treatment options and evaluation of postoperative outcomes in patients with small renal tumors. This study aimed to evaluate the clinical application efficacy of the R.E.N.A.L. nephrometry score (RNS) in predicting perioperative outcomes in patients with renal tumor who underwent laparoscopic partial nephrectomy (LPN).Methods:The clinical data of 139 patients with renal tumors who underwent LPN between 2009 and 2015 were collected and analyzed. Patients were divided into three groups according to their RNS (low, moderate, and high). Clinical characteristics including perioperative variables, complications, and RNS were compared to evaluate the differences between the three groups. Multivariable logistic regression analysis was used to analyze the risk factors of postoperative complications.Results:According to the RNS, there were 74, 50, and 15 patients in the low, moderate, and high RNS groups, respectively. There were significant differences in estimated blood loss (EBL; χ2 = 7.285, P = 0.026), warm ischemia time (WIT; χ2 = 13.718, P = 0.001), operation time (OT; χ2 = 6.882, P = 0.032), perioperative creatinine clearance change (PCCC; χ2 = 6.206, P = 0.045), and number of patients with complications (NPC; P = 0.002) among the three groups. The values for EBL, WIT, OT, PCCC, and NPC for patients in the high RNS group were higher than those for patients in the low RNS group. After adjustment for OT, WIT, and EBL, RNS was statistically significantly associated with the risk of postoperative complications in a multivariable logistic regression model (odds ratio = 1.541, 95% confidence interval: 1.059–2.242, P = 0.024).Conclusions:The RNS is a valuable tool for evaluating the complexity of renal tumor anatomy. It can aid surgeons in preoperative decision-making concerning management therapy. Future multicenter, large sample size studies are warranted for evaluating its predicting performance of perioperative outcomes.

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Predicting outcomes in partial nephrectomy: is the renal score useful?

Cited by 11 publications

References 29 publications

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

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

Positive Surgical Margins After Partial Nephrectomy: A Systematic Review and Meta-Analysis of Comparative Studies

Role of R.E.N.A.L. Nephrometry Score in Laparoscopic Partial Nephrectomy

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