Predictive Value of Nephrometry Scores in Nephron-sparing Surgery: A Systematic Review and Meta-analysis

Abstract

Context: Over the last decade, several nephrometry scores (NSs) have been introduced with the aim of facilitating preoperative decision making, planning, and counseling in the field of nephron-sparing surgery. However, their predictive role remains controversial. Objective: To describe currently available nephrometry scores and to determine their predictive role for different outcomes by performing a systematic review and metaanalysis of the literature. Evidence acquisition: PubMed, Embase1, and Web of Science were screened to identify eligible studies. Identification and selection of the reports were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A pooled analysis of NS predictive role of intraoperative, postoperative, oncological, and functional outcomes was performed. Odds ratio was considered the effect size. All the analyses were performed using Stata 15.0, and statistical significance was set at p 0.05. Evidence synthesis: Overall, 51 studies meeting our inclusion criteria were identified and considered for the analysis. Except for one prospective randomized trial, all the studies were retrospective. All the studies were found to be of intermediate quality, except for one of high quality. Most studies assessed the predictive role of the Radius-Exophytic/Endophytic-Nearness-Anterior/Posterior-Location (RENAL) and Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) scores, mostly regarding complications after nephron-sparing surgery. RENAL was an independent predictor of an on-clamp procedure (p < 0.001). Mayo Adhesive Probability score was related to adhesive perinephric fat (p = 0.005). Continuous and high-complexity RENAL scores were predictors of warm ischemia time (WIT; p = 0.006 and p < 0.001, respectively). Continuous (p < 0.001) and high-complexity (p < 0.001) PADUA scores were related to WIT. Continuous and high-complexity RENAL scores were predictors of overall complications (p = 0.002 and p < 0.001, respectively). PADUA score was related to complications both as continuous (p < 0.001) and as a categorical value (p < 0.002). The RENAL scores R = 3 (p = 0.008), E = 2 (p = 0.039), and hilar location (p = 0.006) were predictors of histological malignancy. Continuous and categorical RENAL scores were independent

Robotic-assisted Partial Nephrectomy for “Very Small” (<2 cm) Renal Mass: Results of a Multicenter Contemporary Cohort

“…Our analysis provides some interesting findings that are worth discussing. Not surprisingly, these "very small" masses present lower complexity (a lower RENAL score, a lower rate of hilar tumors, and completely endophytic localization) [15]. Anatomic tumor characteristics are obviously considered in the decision-making process for the management of renal masses.…”

Laparoscopic and Robotic-Assisted Partial Nephrectomy: An Overview of Hot Issues

“…1). Many studies have shown that RNS is significantly associated with perioperative outcomes and complications [20][21][22][23][24][25]. Another study by Satasivam et al [26] showed that an increase in RNS is associated with histological features of tumor aggressiveness.…”

“…Correlations with WIT, ORT, and percent change in eGFR [21,23,25] Predict the perioperative and postoperative complications; indicate ischemia time [22,25] Predict collecting system entry [23] Associated with the type of surgical approach (open vs. laparoscopic/robotic) and urine leak [24] PADUA Correlated with WIT, ORT, blood loss, and UCS repair [25] Independent predictors of WIT and overall complications [25,27] Predict the perioperative and postoperative complications; indicate ischemia time [22,25,27] Centrality index score Correlations between complexity categories and WIT, ORT, and EBL [21] Associated with WIT [21] Diameter-axial-polar score Estimate the complexity of tumor characteristics better than the RENAL score [29] Associated with kidney volume preservation [31] ABC Associated with EBL, warm and cold ischemia time, and urinary fistula [30] WIT, warm ischemia time; ORT, operation time; eGFR, estimated glomerular filtration rate; EBL, estimated blood loss; UCS, urinary collecting system.…”

“…A series of studies have been conducted and found a high RENAL or PADUA score is correlated with an increased risk of complications [22,25,27]. Hemorrhage is a common complication during RAPN and LPN.…”

Three‐dimensional virtual reconstruction with DocDo, a novel interactive tool to score renal mass complexity

“…Preoperative knowledge of the complexity of a renal mass is the cornerstone for planning a partial nephrectomy (PN) [1]. Given the multiple variables characterizing it – size, length of protrusion from renal parenchyma, longitudinal and coronal location, proximity to the hilum – several nephrometric scoring systems have been proposed during the last decade [2,3]; the RENAL and PADUA classifications are the most widely used of these [4‐6]. Such systems are based, however, on conventional two‐dimensional (2D) imaging rendered as greyscale, which requires a type of cognitive three‐dimensional (3D) reconstruction of a complex structure such as the kidney.…”