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

• Published in: International Brazilian Journal of Urology Vol. 43; no. 3; pp. 422 - 431
• Main Authors: Matos, André Costa, Dall'Oglio, Marcos F, Colombo, Jr, José Roberto, Crippa, Alexandre, Juveniz, João A Q, Argolo, Felipe Coelho
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Urologia 01-05-2017
• Subjects: Aged; Female; Humans; Kidney - pathology; Kidney Neoplasms - diagnosis; Kidney Neoplasms - surgery; Laparoscopy - methods; Male; Neoplasm Staging; Nephrectomy; Operative Time; Original; Patients; Perioperative Period; Prospective Studies; Reproducibility of Results; Robotic Surgical Procedures; Sensitivity and Specificity; Treatment Outcome; Operative Time; Nephrectomy; Patients
• ISSN: 1677-5538; 1677-6119; 1677-6119; 1677-5538
• DOI: 10.1590/S1677-5538.IBJU.2016.0315

The R.E.N.A.L. nephrometry system (RNS) has been validated in multiple open, laparoscopic and robotic partial nephrectomy series. The aim of this study was to test the accuracy of R.E.N.A.L. nephrometry system in predicting perioperative outcomes in surgical treatment of kidney tumors <7.0cm in a prospective model.
Seventy-one patients were selected and included in this prospective study. We evaluate the accuracy of RNS in predicting perioperative outcomes (WIT, OT, EBL, LOS, conversion, complications and surgical margins) in partial nephrectomy using ROC curves, univariate and multivariate analyses. R.E.N.A.L. was divided in 3 groups: low complexity (LC), medium complexity (MC) and high complexity (HC).
No patients in LC group had WIT >20 min, versus 41.4% and 64.3% MC and HC groups respectively (p=0.03); AUC=0.643 (p=0.07). RNS was associated with convertion rate (LC:28.6% ; MC:47.6%; HC:77.3%, p=0.02). Patients with RNS <8 were most often subjected to partial nephrectomy (93% x 72%, p=0.03) and laparoscopic partial nephrectomy (56.8% x 28%, p=0.02), AUC=0.715 (p=0.002). The RNS was also associated with operative time. Patients with a score >8 had 6.06 times greater chance of having a surgery duration >180 min. (p=0.017), AUC=0.63 (p=0.059). R.E.N.A.L. score did not correlate with EBL, complications (Clavien >3), LOS or positive surgical margin.
R.E.N.A.L. score was a good method in predicting surgical access route and type of nephrectomy. Also was associated with OT and WIT, but with weak accuracy. Although, RNS was not associated with Clavien >3, EBL, LOS or positive surgical margin.