963 THE RENAL NEPHROMETRY SCORING SYSTEM IS PREDICTIVE OF PARTIAL NEPHRECTOMY COMPLEXITY

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging1 Apr 2011963 THE RENAL NEPHROMETRY SCORING SYSTEM IS PREDICTIVE OF PARTIAL NEPHRECTOMY COMPLEXITY Patrick Kenney, Spencer Kozinn, Christopher Lebeis, Yoojin Lee, John Libertino, and Alireza Moinzadeh Patrick KenneyPatrick Kenney Burlington, MA More articles by this author , Spencer KozinnSpencer Kozinn Burlington, MA More articles by this author , Christopher LebeisChristopher Lebeis Burlington, MA More articles by this author , Yoojin LeeYoojin Lee Boston, MA More articles by this author , John LibertinoJohn Libertino Burlington, MA More articles by this author , and Alireza MoinzadehAlireza Moinzadeh Burlington, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.931AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The RENAL Nephrometry Scoring System was proposed to aid in surgical planning and to permit better comparison of data by quantifying the complexity of renal masses. We sought to determine if the Nephrometry Scoring System is associated with partial nephrectomy complexity. METHODS A binary composite endpoint of partial nephrectomy complexity was determined a priori and defined as presence of one or more of the following: positive surgical margin, estimated blood loss (EBL) > 1 standard deviation above mean, urine leak, any ≥ Clavien Grade 3 complication, and new onset of ≥Grade 3 chronic kidney disease (CKD) defined as eGFR < 60 mL/min/1.73m2 (e.g., including change from Grade 3 to 4). Data were retrospectively obtained for patients who had partial nephrectomy for renal mass at one institution from 2007–2009 (n = 299). Patients were excluded if imaging was unavailable or if imaged >6 months prior to surgery (n = 58), if multiple tumors were resected (n = 28), or if the kidney was ectopic (n = 1). 2 blinded physicians reviewed the preoperative CTs or MRIs and assigned a Nephrometry score. The Mantel-Haenszel Chi-Square Test was used to test for association between Nephrometry score and the composite complexity endpoint. RESULTS Among the 212 patients included, mean Nephrometry score was 7.5 ± 1.8. 17 patients (8%) had a positive surgical margin, 31 (14.6%) had EBL > 1 standard deviation above the mean, 21 (9.9%) had a urine leak, 23 (10.8%) had at ≥ one Clavien grade 3 or higher complication, and 23 (10.8%) had new onset of ≥ Grade 3 CKD. 85 patients (40.1%) met the composite complexity endpoint. Nephrometry score was significantly associated with the complexity of partial nephrectomy (p <0.01). With each additional Nephrometry point, the odds of meeting the complexity endpoint increased 1.37 times (OR 1.37, p <0.01). CONCLUSIONS The RENAL Nephrometry Scoring System has highly significant association with complexity of partial nephrectomy, as measured by a composite endpoint. Nephrometry may aid in surgical planning and standardize comparison of partial nephrectomy data. Table 1. Demographics, operative details, pathology and peri-operative outcomes Mean age (years) 60+/−12 White 196(92%) Black 5(2%) Asian 2(1%) Other/unknown race 9(4%) Mean Body Mass Index(kg/m2) 30.8+/−6.3 Mean Charlson Comorbidity Index 1.1+/−1.7 Mean American Society of Anesthesiologists Class 2.3+/−0.5 Mean Preoperative eGFR (mL/min/1.73m2) 75+/−20 Solitary kidney 13(6.1%) Symptomatic presentation 48(22.6%) Bilateral masses 18(8.5%) Open 167(79%) Robotic or pure laparoscopic 45(21%) Vascular clamping 56(26%) Mean clamp time(minutes) 26+/−9 Mean EBL(mL) 567+/−550 Mean procedure duration (minutes) 217+/−75 RCC 174(82%) pT1a 118(67.8) pT1b 43(24.7%) pT2 2(1.1%) pT3a 8(4.6%) pT3b 3(1.7%) Mean Fuhrman grade 2.1+/−0.6 Mean Pathologic Tumor size (cm) 3.2+/−1.6 Mean length of stay (days) 4.9+/−2.5 Mean post-operative eGFR (mL/min/1.73m2) 72+/−24 Mean% Decrease in eGFR 4.8+/−18.7 Mean num. days after surgery GFR checked 22+/−19 © 2011 by Americ