Utility of Anteroposterior Diameter Ratio of Tumor and Abdomen for Laparoscopic Approach for Radical Nephrectomy in Large Renal Masses

Yadav, Priyank; Srivastava, Deepakshi; Arakere, Sachin; Gupta, Shashikant; Aga, Pallavi; Mandhani, Anil

doi:10.5301/uj.5000257

Cited by 3 publications

(6 citation statements)

References 25 publications

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“…During laparoscopic right radical nephrectomy, conversion to open surgery does not epitomize failure but is a safeguard against complications. 8 A young surgeon in the early phase of his career, such as a trainee urologist or a junior consultant may need a guide to assess such difficult cases. It is therefore worth investing in a score that allows selection of such cases.…”

Section: Discussionmentioning

confidence: 99%

“…While there are other scoring systems for the evaluation of renal masses, they are not specific for right renal masses. 4,8,20 Further, these scores have often failed to show correlation with blood loss, operating time, complications and hospital stay. 26,27 This can be explained by the fact that they do not cover numerous aspects of renal masses, as discussed before.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 We identified some intraoperative factors leading to difficulty in progression and complications. 5,8 The search of existing literature did not reveal any imaging study which could preoperatively predict the factors leading to the intraoperative difficulties as identified by us and others. Preoperative angioembolisation (PAE) in select cases could significantly reduce the conversion rate and therefore the associated morbidity.…”

Section: Introductionmentioning

confidence: 88%

“…Antero Posterior Diameter Ratio of Tumor and Abdomen or APROTA is a concept that highlights the fact that the greatest tumor dimension per se may not be as important a predictor of feasibility of LRN as previously thought to be. 8 Apart from the size of the mass, the volume of the abdomen also decides the available working space. If we compare a thin patient with an obese patient, handling a 10 cm mass produces different results.…”

Section: Methodsmentioning

confidence: 99%

“…Median blood loss was 100 ml (50-1000). Median postoperative stay was 5 days(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

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confidence: 99%

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A Computed Tomography Angiography (CTA): Based score (SGPGI score) to predict level of difficulty, operative, and postoperative outcomes for right-sided radical nephrectomy

et al. 2021

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Objective: With the advent of laparoscopic approach for the large (T1b–T3a ± N1) right renal masses, higher rates of complications and conversion to open surgery are being reported. The role of preoperative angioembolization (PAE), which has increased cost and inherent morbidity but may help in select circumstances has also not been clearly defined in the literature. We therefore devised a scoring system (SGPGI score) based on pre-operative Computed Tomography Angiography (CTA) to predict the level of difficulty of radical nephrectomy and enhance its safety and efficacy which could also be used for the judicious use of PAE in selected cases. Methods: In a prospective observational study on 52 patients with right renal masses from January 2014 to July 2018, we calculated a score based on CTA parameters. The patients were stratified for type and duration of surgery, blood loss, postoperative stay, and Clavien-Dindo grade of postoperative complications. Results: Patients were classified into three groups based on our scoring system. Progressively groups with higher score had higher blood loss, operating time, complications and hospital stay, and were more likely to have undergone conversion to open surgery (Area under curve 0.8625 for a cut off score of 10). Intraclass Correlation Coefficient (ICC) was 0.678–1 for the different components of our score. Conclusion: The pre-operative CTA based SGPGI score evaluates right renal masses and is able to predict intra-operative difficulties effectively, leading to enhancement of surgery safety and efficacy. It also helps judiciously use PAE.

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Section: Discussionmentioning

confidence: 99%