The role of RENAL, PADUA and C-index scoring systems in predicting the results of partial nephrectomy without ischemia

Asian J Surg. 2019 Jan;42(1):326-331. doi: 10.1016/j.asjsur.2018.06.006. Epub 2018 Aug 6.

Abstract

Objective: To evaluate the feasibility and renoprotective effect of off-clamp partial nephrectomy (PN) by renal scoring systems.

Methods: After approval of the local ethics committee, the radiological and clinical data of patients with renal masses who underwent PN between January 2012 and January 2017 were evaluated in two university hospitals. Total 132 patients who underwent open surgery and off-clamp technique were included. All patients underwent contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) preoperatively. Preoperative demographic data, estimated glomerular filtration rate (e-GFR) and hematocrit changes, operation time, tumor volume and hospitalization time from patients were evaluated separately and statistically for each of the three scoring systems.

Results: Our study consisted of 132 patients with a mean age of 53.9 ± 13.9 with 69 male and 63 female. Statistically significant difference between the risk groups in RENAL and PADUA scoring were found according to tumor T stage and tumor volüme (p <0.005). Statistically significant difference was only found between risk groups of RENAL scoring system in e-GFR reduction (p<0.05). There was no statistically significant difference between the groups in the complications of all three classification systems (p > 0.005).

Conclusions: In our study, all three scoring sytem successfully predicted the surgical complexity ve surgical outcomes and our results indicate that off-clamp PN has similar success and complications rates when compared to the literature. The off-clamp PN must be kept in mind to maintain postoperative renal functions eligible patients.

Keywords: C-index; Off-clamp; PADUA; Partial nephrectomy; RENAL.

MeSH terms

  • Adult
  • Aged
  • Feasibility Studies
  • Female
  • Glomerular Filtration Rate
  • Hematocrit
  • Humans
  • Kidney Neoplasms / diagnosis*
  • Kidney Neoplasms / diagnostic imaging
  • Kidney Neoplasms / pathology
  • Kidney Neoplasms / surgery*
  • Length of Stay
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Nephrectomy / methods*
  • Operative Time
  • Predictive Value of Tests
  • Risk
  • Tomography, X-Ray Computed
  • Treatment Outcome