The association between renal tumour scoring systems and ischemia time during open partial nephrectomy

Lavallée, Luke T.; Desantis, Darren; Kamal, Fadi; Blew, Brian; Watterson, James; Mallick, Ranjeeta; Fergusson, Dean; Morash, Christopher; Cagiannos, Ilias; Breau, Rodney H.

doi:10.5489/cuaj.11202

Cited by 19 publications

(15 citation statements)

References 16 publications

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“…No significant correlations were found between any of the subscales and percent change in eGFR from baseline. Our results, corroborated by the heterogeneity of outcomes from other studies [9 10,11,12…”

Section: Discussionsupporting

confidence: 89%

Interobserver variability of R.E.N.A.L., PADUA, and centrality index nephrometry score systems

et al. 2014

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Purpose To assess interobserver variability of R.E.N.A.L., PADUA, and C-Index systems among observers with varying degrees of clinical experience and each system's subscale correlation with surgical outcome metrics. Methods Computed tomography images of 90 patients who underwent open, laparoscopic, or robot-assisted laparoscopic partial nephrectomy were scored by 1 radiology fellow, 2 urology fellows, 1 radiology resident, and 1 secondary school student. Agreement among readers was determined calculating intraclass correlation coefficients. Associations between radiology fellow scores (reference standard as reader with greatest clinical experience), ischemia time, and percent change in postoperative eGFR were evaluated using Spearman correlation. Results Agreement using C-Index method (ICC = 0.773) was higher than with PADUA (ICC = 0.677) or R.E.N.A.L (ICC = 0.660). Agreement between reference and secondary school student was lower than with other physicians, although the differences were not statistically significant. The reference's scores were significantly (p <0.05) associated with ischemia time on all three scoring systems and with percent change in eGFR at 6 weeks using C-index (p = 0.016). Tumor size, nearness to sinus, location relative to polar lines (R.E.N.A.L.) and tumor size, renal sinus involvement and collecting system involvement (PADUA) correlated with ischemia time (all p ≤0.001). No R.E.N.A.L. or PADUA subscales significantly correlated with percent change in postoperative eGFR. Conclusions Clinical experience reduces interobserver variability of existing nephrometry systems though not significantly and less so when using directly measureable anatomic variables. Consistently, only measures of tumor size and distance to intrarenal structures were useful in predicting clinically relevant outcomes.

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Section: Discussionsupporting

confidence: 89%

Interobserver variability of R.E.N.A.L., PADUA, and centrality index nephrometry score systems

et al. 2014

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“…10 In their OPN series, Lavallee and colleagues found that several parameters of tumour complexity positive correlated with warm ischemic time. 19 However, Mufarrij and colleagues demonstrated that nephrometry-graded tumour complexity was not related to warm ischemic time for 92 patients who underwent RPN. 20 Their interpretation was that since their series was based on the skills of a highly experienced laparoscopic and robotic surgeons, differences between simple and complex cases were too minuscule to detect.…”

Section: Discussionmentioning

confidence: 99%

Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

Park

Hwang

Kang

et al. 2014

CUAJ

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. Tumour complexity was stratified into 3 categories: low (4-6), moderate (7-9) and high (10-12) complexity. Perioperative outcomes, such as complications, cold ischemic time, estimated blood loss and renal function, were analyzed according to the complexity by NS. Complications were stratified using the Clavien-Dindo classification system. Results: Tumour complexity according to nephrometry score was assessed as low in 16 (16.3%), moderate in 48 (49.0%) and high in 34 (34.7%). The median cold ischemic time did not differ significantly among the 3 groups (36.0 minutes in low-, 40 minutes in moderate-and 43 minutes in the high-complexity group, p = 0.421). Total complications did not differ significantly (2 (2.0%) in low, 4 (4.1%) in moderate and 4 (4.1%) in high, p = 0.984). Each Grade 3 complication occurred in the moderate (urine leakage) and high groups (lymphocele). Postoperative renal functional outcomes were similar among the groups (p = 0.729). Only mean estimated blood loss was significantly different with nephrometry score (p = 0.049). Conclusions:The nephrometry score, as used in an open PN series under cold ischemia, was not significantly associated with perioperative outcomes (i.e., ischemia time, complications, renal functional preservation).

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“…As a result, this sometimes limits their abilities to effectively reflect the surgical complexity and predict the risk of surgical complications. We found that each system's ability to predict clinical outcomes of PN has been inconsistent between studies . Furthermore, morphological descriptors, such as the exophytic rate and anterior/posterior descriptor in the RENAL nephrometry scoring system and the anterior or posterior face, longitudinal, and rim tumor location, and exophytic rate in the PADUA scoring system, appear clinically irrelevant for predicting clinical outcomes of PN …”

Section: Introductionmentioning

confidence: 91%

DDD score for renal tumor: An intuitive and comprehensive anatomical scoring system to access the outcomes of retroperitoneal laparoscopic partial nephrectomy

et al. 2019

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Objective To present a DDD scoring system in assessing the complexity and outcomes of retroperitoneoscopic nephron‐sparing surgery for kidney tumor. Methods We retrospectively evaluated 232 patients who underwent retroperitoneoscopic nephron‐sparing surgery between January 2013 and September 2017 for a renal tumor. Both the DDD score and RENAL score were used to classify the tumors. The DDD score consisted of the maximal tumor diameter inside the kidney, the maximal tumor depth into the medulla or collecting system and the minimal distance from the tumor to the main renal vessels. Results The DDD scoring systems were significantly associated with warm ischemia time (P = 0.007) and estimated blood loss (P = 0.017). There was an insignificant positive correlation between the DDD score and the operative time (P = 0.051). Meanwhile, the RENAL score had a significant correlation with the decreasing value of the estimated glomerular filtration rate. Patients with high or moderate DDD scores had a 13.6‐fold or 8.4‐fold risk of overall complications than those with low DDD scores, respectively (all P < 0.05). As for RENAL score, patients with moderate scores had a 2.9‐fold risk of overall complications compared with patients in the low scores group (P = 0.004). In the receiver operating characteristic curve analysis, the DDD score had the greatest area under the curve for overall complications (area under the curve 0.625, P = 0.009), which was more than the RENAL score (area under the curve 0.620, P = 0.013). Conclusions The DDD score is an intuitive renal tumor scoring system that is more effective than the RENAL score in complexity assessment, and marginally better in prediction of the risk of overall complications of retroperitoneal laparoscopic nephron‐sparing surgery.

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The association between renal tumour scoring systems and ischemia time during open partial nephrectomy

Cited by 19 publications

References 16 publications

Interobserver variability of R.E.N.A.L., PADUA, and centrality index nephrometry score systems

Interobserver variability of R.E.N.A.L., PADUA, and centrality index nephrometry score systems

Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

DDD score for renal tumor: An intuitive and comprehensive anatomical scoring system to access the outcomes of retroperitoneal laparoscopic partial nephrectomy

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