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Comparing technology-based scoring systems for retroperitoneoscopic partial nephrectomy

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Abstract

Nephrometry scores play a critical role in the preoperative evaluation of partial nephrectomy. Although score comparisons have been performed for transperitoneal or open surgery, systematic comparisons for retroperitoneal operations are lacking. Authors have retrospectively evaluated the clinical records of patients who underwent partial nephrectomy at one center by one surgeon. Scores were generated according to the imaging results, and each score was categorized into low-, intermediate- and high-complexity groups. Then, the differences in perioperative outcomes were compared among the groups. We assessed whether the scores and sex, body mass index (BMI), age, or American Society of Anesthesiologists (ASA) Physical Status classification could predict whether the warm ischemia time (WIT) was likely be longer than 20 min and whether they could predict postoperative complications worse than Clavien–Dindo 1. The interobserver variability between two experienced surgeons for these scores was calculated with the intraclass correlation coefficient (ICC). Total of 107 patients were ultimately evaluated. The scores included in this study were significantly associated with the probability of having a WIT > 20 min and high-grade postoperative complications. Receiver Characteristic Operator (ROC) curves showed that there were no significant differences in their predictive power. NePhRo had the highest agreement (0.839), followed by DAP (0.827). RENAL was superior to SPARE and PADUA, which were 0.758, 0.724 and 0.667, respectively.

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Availability of data and materials

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

RENAL:

(R)adius (tumor size as maximal diameter), (E)xophytic/endophytic properties of the tumor, (N)earness of tumor deepest portion to the collecting system or sinus, (A)nterior (a)/posterior (p) descriptor and the (L)ocation relative to the polar line

PADUA:

Preoperative aspects and dimensions used for an anatomical

DAP:

Diameter-axial-polar nephrometry

NePhRo:

(Ne)arness to collecting system, (Ph)ysical location of the tumor in the kidney, (R)adius of the tumor, and (O)rganization of the tumor

SPARE:

The Simplified PADUA renal

BMI:

Body mass index

ASA:

American Society of Anesthesiologists

WIT:

Warm ischemia time

ICC:

Intraclass correlation coefficients

OT:

Operation time

EBL:

Estimated blood loss

ROC:

Receiver characteristic operator

PN:

Partial nephrectomy

RLPN:

Retroperitoneal laparoscopic partial nephrectomy

TLPN:

Transperitoneal laparoscopic partial nephrectomy

RN:

Radical nephrectomy

ABC:

An arterial based complexity

CT:

Computerized tomography

MRI:

Magnetic resonance imaging

AUC:

Area under curve

DDD:

(D1)iameter (scores tumor size as maximal diameter inside of kidney), (D2)epth of the deepest portion of the tumor with the medulla and collecting system or sinus, and (D3)istance shortest from the mass to the main renal vessels (including the early branch vessels) in the renal hilum

RNP:

Tumor radius (R score), nearness to the renal sinus or collecting system (N score), and posterior perinephric fat thickness

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Funding

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Authors and Affiliations

  1. Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

    Yanyang Jin, Mingshuai Wang & Nianzeng Xing

  2. Perdana University, Kuala Lumpur, Malaysia

    Valliappan Raju

  3. National Cancer Center, Chinese Academy of Medical Sciences, Beijing, China

    Feiya Yang & Nianzeng Xing

Authors
  1. Yanyang Jin
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  2. Valliappan Raju
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  3. Mingshuai Wang
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  4. Feiya Yang
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  5. Nianzeng Xing
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Contributions

YY Jin: contributed to the study design, analysis, and writing of the manuscript. MS Wang: contributed to the analysis and interpretation of the data, statistical analysis and writing of the manuscript. FY Yang: contributed to the study design and revision of the article. NZ Xing: contributed to the study design, interpretation of the data, and revision of the article; All the authors read and approved the final manuscript.

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Correspondence to Nianzeng Xing.

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This study was approved by the Institutional Review Board of Beijing Chaoyang Hospital and was conducted in accordance with the Declaration of Helsinki and all patients signed informed consent.

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Jin, Y., Raju, V., Wang, M. et al. Comparing technology-based scoring systems for retroperitoneoscopic partial nephrectomy. Microsyst Technol 30, 661–671 (2024). https://doi.org/10.1007/s00542-024-05620-3

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