687 EFFECT OF R.E.N.A.L NEPHROMETRY SCORE ON PERI-OPERATIVE OUTCOMES IN MINIMALLY INVASIVE PARTIAL NEPHRECTOMY

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You have accessJournal of UrologyKidney Cancer: Evaluation and Staging1 Apr 2011687 EFFECT OF R.E.N.A.L NEPHROMETRY SCORE ON PERI-OPERATIVE OUTCOMES IN MINIMALLY INVASIVE PARTIAL NEPHRECTOMY Jonathan Ellison, Jeffery Montgomery, Khaled Hafez, David Miller, Chang He, Stuart Wolf, and Alon Weizer Jonathan EllisonJonathan Ellison Ann Arbor, MI , Jeffery MontgomeryJeffery Montgomery Ann Arbor, MI , Khaled HafezKhaled Hafez Ann Arbor, MI , David MillerDavid Miller Ann Arbor, MI , Chang HeChang He Ann Arbor, MI , Stuart WolfStuart Wolf Ann Arbor, MI , and Alon WeizerAlon Weizer Ann Arbor, MI View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1654AboutPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent American Urologic Association guidelines recognize the important role of nephron sparing techniques for small renal masses. Conventional laparoscopic (CLPN) and robotic-assisted (RAPN) approaches are accepted minimally-invasive approaches for partial nephrectomy. The R.E.N.A.L. Nephrometry system stratifies renal masses by several tumor characteristics in order to objectively identify more complex tumors. Our study aimed to validate this scoring system and determine the importance of individual components. METHODS All CLPN (N = 161) and RAPN (N = 75) cases since 2007 were reviewed from our institution's prospectively maintained database. Urologic surgeons assigned R.E.N.A.L. scores excluding cases without images available for review. Groups were divided into tertiles by total R.E.N.A.L. score as well as individual components of the score. Statistical analyses were performed. RESULTS No difference was observed in pre-operative characteristics between low (n = 108), intermediate (n = 122) and high (n = 6) R.E.N.A.L groups. Higher overall R.E.N.A.L. scores were associated with an increased length of stay (LOS), estimated blood loss (EBL), and average warm ischemia time (WIT). Compared to the low score group, the intermediate group had higher rates of malignant pathology (p = 0.03), overall complications (p = 0.04), and complications of Clavien 3 or greater (p = 0.04). Distance to the renal sinus and tumor diameter were associated with statistically significant differences in LOS (p < 0.0001, 0.004), WIT (p < 0.0001, 0.04), and EBL (p = 0.001, 0.002), while tumor polarity only significantly impacted WIT (p = 0.04). Anterior-posterior location and exophytic nature of the tumor were not associated with significant differences in outcomes. CONCLUSIONS The R.E.N.A.L. Nephrometry score can be a useful tool in stratifying small renal masses, as higher scores are associated with significant differences in peri-operative outcomes. Tumor diameter and distance to the renal sinus appear to be the two most important features of the scoring system in terms of predicting risk of complications. Pre-operative Characteristics, Peri-operative Outcomes, and Complications Stratified by R.E.N.A.L Nephrometry Score Low (4-6) Intermediate (7-9) High (10-12) Pre-Operative Characteristics Age (years) 57.2>0.9 55.8>1.4 59.5>6.1 Gender Male 61 80 3 Female 47 42 3 ASA 2.31>0.06 2.39>0.05 2.17>0.31 Pre-operative Creatinine (mg/dL) 0.95>0.25 0.97>0.23 0.83>0.15 Peri-Operative Outcomes Estimated Blood Loss (mL) ∂ 274.5>29.9 553.0>90.1 238.3>86.8 Warm Ischemia Time (min) ∂ 25.7>1.5 31.0>1.2 38.8>8.0 Length of Stay (days) ∂ 2.2>0.2 3.2>0.2 3.2>0.7 Post-operative Creatinine (mg/dL) 1.0>0.4 1.1>0.6 0.9>0.2 Operative Time (min) 189.8>221.9 230>227.3 257.7>77.7 Complications Complication Rate (%) ∂ 33.3% 46.8% 33.3% Minor Complications (Clavien 1-2) 42 65 1 Major Complications (Clavien 3-5) ∂ 4 21 1 ∂ Denotes statistical significance between low and intermediate groups © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesR