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

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Vol. 43 (3): 422-431, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0315


ORIGINAL ARTICLE

André Costa Matos 1, Marcos F. Dall´Oglio 2, José Roberto Colombo Jr. 2, 3, Alexandre Crippa 4, João A. Q. Juveniz 2, Felipe Coelho Argolo 1
1 Hospital São Rafael, Salvador, BA, Brasil; 2 Departamento de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil; 3 Departamento de Uro-Oncologia,Instituto do Câncer do Estado de São Paulo, SP, Brasil; 4 Serviço de Urologia, Hospital do Servidor Público Municipal de São Paulo – HSPM, SP, Brasil

ABSTRACT

Introduction and Objective: 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.

Materials and Methods: 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).

Results: 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.

Conclusion: 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.

Keywords:  Nephrectomy; Operative Time; Patients

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