Prediction of perioperative outcomes following minimally invasive partial nephrectomy: Role of the R.E.N.A.L nephrometry score

Zhuo Wei Liu, Ephrem O. Olweny, Gang Yin, Stephen Faddegon, Yung K. Tan, Woong Kyu Han, Jeffrey A. Cadeddu

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objectives: Objective characterization of renal mass anatomy facilitates treatment selection and prediction of surgical outcomes. We investigated R.E.N.A.L nephrometry score (NS) efficacy in predicting outcomes after minimally invasive nephron-sparing surgery (MINSS). Methods: A total of 250 patients with 252 renal masses underwent MINSS by a surgeon between January 2003 and July 2011. Preoperative films were available for 181 (72 %) renal masses, which were retrospectively assigned a NS. NS was categorized as low, moderate or high, reflecting tumor complexity. Perioperative outcomes were analyzed by NS category. Outcomes for laparoscopic (LPN) versus robotic (RALPN) partial nephrectomy were compared. Multivariable regression was used to investigate predictors of postoperative complications. Results: Among 181 renal masses, 128 (71 %) were managed by LPN and 53 were (29 %) by RALPN. And 103, 74 and 4 renal lesions were low, medium and high complexity, respectively. For low versus medium versus high NS, respective overall complication rate was 5.8 versus 16.0 versus 50.0 % (p = 0.01); mean warm ischemia time (WIT) was 29 versus 33 versus 39 min (p = 0.02); and transfusion rate was 5/103 (4.8 %) versus 6/74 (8.1 %) versus 1/4 (25 %) (p = 0.20). NS category was significantly associated with overall complication rate (p = 0.04) and Clavien grade III complication rate (p = 0.05). Nearness to the collecting system ("N") was significantly associated with overall complications (p = 0.02) and postoperative hemorrhage (p = 0.02). Postoperative outcomes for LPN versus RALPN were statistically similar across all categories. Conclusions: R.E.N.A.L NS is predictive of overall complications and WIT during MINSS. Our data also suggest that "N" score may be used as a single predictor of overall complications and postoperative hemorrhage following MINSS.

Original languageEnglish
Pages (from-to)1183-1189
Number of pages7
JournalWorld Journal of Urology
Volume31
Issue number5
DOIs
Publication statusPublished - 2013 Oct 1

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Nephrectomy
Nephrons
Kidney
Warm Ischemia
Postoperative Hemorrhage
Robotics
Anatomy
Neoplasms
Therapeutics

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Liu, Zhuo Wei ; Olweny, Ephrem O. ; Yin, Gang ; Faddegon, Stephen ; Tan, Yung K. ; Han, Woong Kyu ; Cadeddu, Jeffrey A. / Prediction of perioperative outcomes following minimally invasive partial nephrectomy : Role of the R.E.N.A.L nephrometry score. In: World Journal of Urology. 2013 ; Vol. 31, No. 5. pp. 1183-1189.
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abstract = "Objectives: Objective characterization of renal mass anatomy facilitates treatment selection and prediction of surgical outcomes. We investigated R.E.N.A.L nephrometry score (NS) efficacy in predicting outcomes after minimally invasive nephron-sparing surgery (MINSS). Methods: A total of 250 patients with 252 renal masses underwent MINSS by a surgeon between January 2003 and July 2011. Preoperative films were available for 181 (72 {\%}) renal masses, which were retrospectively assigned a NS. NS was categorized as low, moderate or high, reflecting tumor complexity. Perioperative outcomes were analyzed by NS category. Outcomes for laparoscopic (LPN) versus robotic (RALPN) partial nephrectomy were compared. Multivariable regression was used to investigate predictors of postoperative complications. Results: Among 181 renal masses, 128 (71 {\%}) were managed by LPN and 53 were (29 {\%}) by RALPN. And 103, 74 and 4 renal lesions were low, medium and high complexity, respectively. For low versus medium versus high NS, respective overall complication rate was 5.8 versus 16.0 versus 50.0 {\%} (p = 0.01); mean warm ischemia time (WIT) was 29 versus 33 versus 39 min (p = 0.02); and transfusion rate was 5/103 (4.8 {\%}) versus 6/74 (8.1 {\%}) versus 1/4 (25 {\%}) (p = 0.20). NS category was significantly associated with overall complication rate (p = 0.04) and Clavien grade III complication rate (p = 0.05). Nearness to the collecting system ({"}N{"}) was significantly associated with overall complications (p = 0.02) and postoperative hemorrhage (p = 0.02). Postoperative outcomes for LPN versus RALPN were statistically similar across all categories. Conclusions: R.E.N.A.L NS is predictive of overall complications and WIT during MINSS. Our data also suggest that {"}N{"} score may be used as a single predictor of overall complications and postoperative hemorrhage following MINSS.",
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Prediction of perioperative outcomes following minimally invasive partial nephrectomy : Role of the R.E.N.A.L nephrometry score. / Liu, Zhuo Wei; Olweny, Ephrem O.; Yin, Gang; Faddegon, Stephen; Tan, Yung K.; Han, Woong Kyu; Cadeddu, Jeffrey A.

In: World Journal of Urology, Vol. 31, No. 5, 01.10.2013, p. 1183-1189.

Research output: Contribution to journalArticle

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T1 - Prediction of perioperative outcomes following minimally invasive partial nephrectomy

T2 - Role of the R.E.N.A.L nephrometry score

AU - Liu, Zhuo Wei

AU - Olweny, Ephrem O.

AU - Yin, Gang

AU - Faddegon, Stephen

AU - Tan, Yung K.

AU - Han, Woong Kyu

AU - Cadeddu, Jeffrey A.

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N2 - Objectives: Objective characterization of renal mass anatomy facilitates treatment selection and prediction of surgical outcomes. We investigated R.E.N.A.L nephrometry score (NS) efficacy in predicting outcomes after minimally invasive nephron-sparing surgery (MINSS). Methods: A total of 250 patients with 252 renal masses underwent MINSS by a surgeon between January 2003 and July 2011. Preoperative films were available for 181 (72 %) renal masses, which were retrospectively assigned a NS. NS was categorized as low, moderate or high, reflecting tumor complexity. Perioperative outcomes were analyzed by NS category. Outcomes for laparoscopic (LPN) versus robotic (RALPN) partial nephrectomy were compared. Multivariable regression was used to investigate predictors of postoperative complications. Results: Among 181 renal masses, 128 (71 %) were managed by LPN and 53 were (29 %) by RALPN. And 103, 74 and 4 renal lesions were low, medium and high complexity, respectively. For low versus medium versus high NS, respective overall complication rate was 5.8 versus 16.0 versus 50.0 % (p = 0.01); mean warm ischemia time (WIT) was 29 versus 33 versus 39 min (p = 0.02); and transfusion rate was 5/103 (4.8 %) versus 6/74 (8.1 %) versus 1/4 (25 %) (p = 0.20). NS category was significantly associated with overall complication rate (p = 0.04) and Clavien grade III complication rate (p = 0.05). Nearness to the collecting system ("N") was significantly associated with overall complications (p = 0.02) and postoperative hemorrhage (p = 0.02). Postoperative outcomes for LPN versus RALPN were statistically similar across all categories. Conclusions: R.E.N.A.L NS is predictive of overall complications and WIT during MINSS. Our data also suggest that "N" score may be used as a single predictor of overall complications and postoperative hemorrhage following MINSS.

AB - Objectives: Objective characterization of renal mass anatomy facilitates treatment selection and prediction of surgical outcomes. We investigated R.E.N.A.L nephrometry score (NS) efficacy in predicting outcomes after minimally invasive nephron-sparing surgery (MINSS). Methods: A total of 250 patients with 252 renal masses underwent MINSS by a surgeon between January 2003 and July 2011. Preoperative films were available for 181 (72 %) renal masses, which were retrospectively assigned a NS. NS was categorized as low, moderate or high, reflecting tumor complexity. Perioperative outcomes were analyzed by NS category. Outcomes for laparoscopic (LPN) versus robotic (RALPN) partial nephrectomy were compared. Multivariable regression was used to investigate predictors of postoperative complications. Results: Among 181 renal masses, 128 (71 %) were managed by LPN and 53 were (29 %) by RALPN. And 103, 74 and 4 renal lesions were low, medium and high complexity, respectively. For low versus medium versus high NS, respective overall complication rate was 5.8 versus 16.0 versus 50.0 % (p = 0.01); mean warm ischemia time (WIT) was 29 versus 33 versus 39 min (p = 0.02); and transfusion rate was 5/103 (4.8 %) versus 6/74 (8.1 %) versus 1/4 (25 %) (p = 0.20). NS category was significantly associated with overall complication rate (p = 0.04) and Clavien grade III complication rate (p = 0.05). Nearness to the collecting system ("N") was significantly associated with overall complications (p = 0.02) and postoperative hemorrhage (p = 0.02). Postoperative outcomes for LPN versus RALPN were statistically similar across all categories. Conclusions: R.E.N.A.L NS is predictive of overall complications and WIT during MINSS. Our data also suggest that "N" score may be used as a single predictor of overall complications and postoperative hemorrhage following MINSS.

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