Renal nephrometry score and predictors of complications in partial nephrectomies.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 512-512
Author(s):  
Deepak K. Pruthi ◽  
Darrel E Drachenberg ◽  
Thomas B McGregor
Keyword(s):  
Partial Nephrectomy ◽  
Univariate Analysis ◽  
Laparoscopic Approach ◽  
Patient Characteristics ◽  
Clinic Visit ◽  
Morbidly Obese ◽  
Complication Rates ◽  
Renal Masses ◽  
Ischemic Time ◽  
Nephrometry Score

512 Background: Feasibility of partial nephrectomy for small renal masses extends beyond standard clinical tumor size. We analyze patient characteristics and anatomic tumor factors to determine variables associated with surgical complications after partial nephrectomy. Methods: Retrospective review of all patients who underwent partial nephrectomy at our institution between January 1, 2012 and Aug 31, 2013. Follow-up extended to 8 week post-operative outpatient clinic visit. The R.E.N.AL. Nephrometry score is a tumor descriptive (the maximum radius, exophytic/endophytic, nearness to collecting system/sinus, anterior/posterior position, location relative to polar line) that was applied to each pre-operative scan. Standardized grading systems and statistical analysis were applied. Results: Of the 83 patients who underwent partial nephrectomy 72 had a laparoscopic approach. Seventeen (20%) patients had complications and seven were Clavien-Dindo grade 3 to 4. Two patients had laparoscopic partial nephrectomies converted intra-operatively to radical nephrectomies; two other laparoscopic partial nephrectomies were converted to open partial nephrectomies. Forty-three (52%) of operated patients were either obese, morbidly obese, or super obese. Fifteen (18%) of patients had pathologic oncocytomas or angiomyelipomas. In univariate analysis Charlson comorbidity score (>6 p=0.0027), diabetes (42% p=0.0195), age (>70 p=0.02034), and total R.E.N.A.L. Nephrometry score (10-12, 67%, p=0.0254) were associated with complications. Nephrometry score also correlated with warm ischemic time (WIT) in laparoscopic cases (low 26 min [SD +/- 11.71], intermediate 31 min [SD +/- 7], high 34 min [SD +/- 14]). Conclusions: Categorizing renal masses according to the R.E.N.A.L. Nephrometry score may help us council patients towards expected WITs, complication rates, and predicted renal function outcomes. This is increasingly important as the majority of our patients are either obese, elderly, or have significant comorbidities; all of which have been shown to be associated with increased complication rates.

scholarly journals Ipsilateral renal function preservation following minimally invasive partial nephrectomy: The effect of tumour characteristics and warm ischemic time

2017 ◽  
Vol 11 (10) ◽  
pp. 344-9 ◽  
Author(s):  
Ernest Chan ◽  
Shawna L. Boyle ◽  
Jeffrey Campbell ◽  
Patrick P.W. Luke
Keyword(s):  
Renal Function ◽  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Renal Parenchyma ◽  
Renal Masses ◽  
Ischemic Time ◽  
Warm Ischemic Time ◽  
Nephrometry Score ◽  
Function Preservation ◽  
Collecting System

Introduction: The relative impact of preoperative and perioperative variables on renal function following partial nephrectomy (PN) is controversial. To further investigate, we assess the effects of tumour complexity, warm ischemic time (WIT), and volume of resected renal parenchyma on ipsilateral renal function (IRF) outcomes following minimally invasive PN.Methods: Of patients who underwent laparoscopic or roboticassisted PN between 2002 and 2011 at our institution, 99 met our inclusion criteria. The effects of preoperative tumour complexity (using RENAL nephrometry score), perioperative WIT, and pathological tumour volumes on ipsilateral renal function preservation (%IRF) were analyzed. %IRF was defined as the proportion of postoperative to preoperative ipsilateral renal function calculated using MAG3 nuclear renography.Results: Increasing RENAL nephrometry score (RNS) and WIT were independently predictive of inferior %IRF at 6‒12-week postoperative followup in univariate and multivariate analyses. Of RNS properties, masses that were endophytic, near the collecting system, or central in location were associated with inferior %IRF, with nearness to collecting system as the strongest predictor; however, RNS was no longer predictive of %IRF in cases requiring more than 30 minutes of WIT.Conclusions: In renal masses amenable to resection by minimally invasive PN, longer WIT was the most important predictor of inferior %IRF. Although increasing RNS score influenced %IRF, the overall clinical significance of RNS is limited and should not influence operative decision-making in efforts to preserve renal function. Furthermore, small volumes of renal parenchyma can be safely resected without impairment of long-term IRF.

scholarly journals Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

2014 ◽  
Vol 8 (3-4) ◽  
pp. 137
Author(s):  
Dong Soo Park ◽  
Jin Ho Hwang ◽  
Moon Hyung Kang ◽  
Jong Jin Oh
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Perioperative Outcomes ◽  
Renal Neoplasm ◽  
Cold Ischemia ◽  
Ischemic Time ◽  
Open Partial Nephrectomy ◽  
Cold Ischemic Time ◽  
Nephrometry Score ◽  
Estimated Blood Loss

Introduction: We investigate the clinical significance of the R.E.N.A.L. nephrometry score for renal neoplasm following open partial nephrectomy (PN) under cold ischemia.Methods: A retrospective analysis was conducted using clinical data of 98 consecutive patients with clear cell renal cell carcinoma who underwent open PN by a single surgeon from December 2000 to September 2012. Tumour complexity was stratified into 3 categories: low (4-6), moderate (7-9) and high (10-12) complexity. Perioperative outcomes, such as complications, cold ischemic time, estimated blood loss and renal function, were analyzed according to the complexity by NS. Complications were stratified using the Clavien-Dindo classification system.Results: Tumour complexity according to nephrometry score was assessed as low in 16 (16.3%), moderate in 48 (49.0%) and high in 34 (34.7%). The median cold ischemic time did not differ significantly among the 3 groups (36.0 minutes in low-, 40 minutes in moderate- and 43 minutes in the high-complexity group, p = 0.421). Total complications did not differ significantly (2 (2.0%) in low, 4 (4.1%) in moderate and 4 (4.1%) in high, p = 0.984). Each Grade 3 complication occurred in the moderate (urine leakage) and high groups (lymphocele). Postoperative renal functional outcomes were similar among the groups (p = 0.729). Only mean estimated blood loss was significantly different with nephrometry score (p = 0.049).Conclusions: The nephrometry score, as used in an open PN series under cold ischemia, was not significantly associated with perioperative outcomes (i.e., ischemia time, complications, renal functional preservation).

scholarly journals Efficacy of Partial Nephrectomy for Renal Tumors >4 cm: Comparison With Renal Tumors ≤4 cm

2016 ◽  
Vol 101 (1-2) ◽  
pp. 7-13
Author(s):  
Ohseong Kwon ◽  
Seok-Soo Byun ◽  
Sung Kyu Hong ◽  
Ja Hyeon Ku ◽  
Cheol Kwak ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Functional Outcomes ◽  
Survival Rates ◽  
Renal Tumors ◽  
Recurrence Free Survival ◽  
Renal Masses ◽  
Ischemic Time ◽  
Free Survival ◽  
Kaplan Meier ◽  
Computed Tomography Image

Partial nephrectomy has become a treatment of choice for clinical T1a renal masses. Some international guidelines suggest that partial nephrectomy can be applied also in clinical T1b tumors. The aim of this study was to evaluate the feasibility of partial nephrectomy for tumors larger than 4 cm. We reviewed the medical records of 1280 patients who underwent partial nephrectomy and had pathologically confirmed malignancy. Patients were categorized into two groups by the size of tumors on computed tomography image, with a cutoff value of 4 cm. The oncologic and functional outcomes were compared between the two groups. Recurrence-free survival after surgery was estimated using the Kaplan-Meier method. Of the 1280 patients, 203 patients (15.9%) had renal tumors larger than 4 cm. There were significantly more exophytic tumors (P < 0.001) and the R.E.N.A.L. scores were significantly higher (P < 0.001) in partial nephrectomy >4 cm. Mean ischemic times were significantly different (P < 0.001). After 24 months, mean creatinine level between partial nephrectomy >4 cm and partial nephrectomy ≤4 cm was not different significantly (P = 0.554). And the percent changes of glomerular filtration rate after partial nephrectomy were not different at last follow-up (P = 0.082). The 5-year recurrence-free survival rates were 96.6% in partial nephrectomy ≤4 cm, and 94.5% in partial nephrectomy >4 cm (P = 0.416). Based on the present findings, partial nephrectomy for tumors larger than 4 cm showed comparable feasibility and safety to partial nephrectomy for tumors ≤4 cm considering oncologic and functional outcomes, despite longer operative and ischemic time.

scholarly journals Safety and efficacy of retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy for low nephrometry score masses

2019 ◽  
Vol 91 (3) ◽  
Author(s):  
Emanuele Corongiu ◽  
Pietro Grande ◽  
Angelo Di Santo ◽  
Giorgio Pagliarella ◽  
Stefano Squillacciotti ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Intraoperative Complications ◽  
Functional Results ◽  
Laparoscopic Partial Nephrectomy ◽  
Tumor Diameter ◽  
Selective Embolization ◽  
Renal Masses ◽  
Nephrometry Score ◽  
Estimated Blood Loss ◽  
Zero Ischemia

Objectives: To evaluate oncological feasibility and oncological and functional results of retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy (LPN). Patients and methods: Patients with posterior renal masses with low nephrometry score (RENAL ≤ 7) treated who underwent retroperitoneal sutureless zero ischemia.in a single center from January 2016 to November 2017. Clinical, surgical and pathological data were prospectively collected. Complications were reported according to the modified Clavien classification. Results: Retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy was performed on 15 patients. The indication for nephron-sparing surgery was elective in 11 (73%) patients and imperative in 4 (27%). Median RENAL score was 5 (IQR: 5-7), median tumor diameter 25 mm (IQR: 20-35). In 11 cases, the tumor was located polar (85%), and in 2 cases hilar (15%). There were no intraoperative complications. No cases were converted to radical nephrectomy, and in no case parenchyma suture was necessary. Median operative time was 90 min (IQR:40-150), in no case clamping of the renal artery was necessary, median hospital stay was 4 days, median estimated blood loss (EBL) was 310 (180-500) ml. Pathological analysis showed renal cell carcinoma in 11 patients (85%), 9 (60%) staged T1a and 2 (13%) T1b. In 4 (27%) an oncocytoma was found. There were no positive surgical margins. One patient developed a major postoperative complication (postoperative renal bleeding requiring super-selective embolization). Trifecta rate was 93%. Conclusions: Sutureless retroperitoneal zero ischemia LPN for the treatment of low-complexity posterior renal masses showed to be safe and feasible. Longer follow-up and higher numbers of patients are, however, warranted to draw definitive conclusions on functional outcomes.

Obesity Does Not Impact Outcomes for Appendicitis

2012 ◽  
Vol 78 (2) ◽  
pp. 254-257 ◽  
Author(s):  
Daniel A. DeUgarte ◽  
Rebecca Stark ◽  
Amy H. Kaji ◽  
Arezou Yaghoubian ◽  
Amy Tolan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Univariate Analysis ◽  
Laparoscopic Approach ◽  
Infectious Complications ◽  
Complication Rates ◽  
Obese Patients ◽  
Lower Complication ◽  
Abstract Data ◽  
Nonobese Patients ◽  
The Impact

Obesity has long been considered a risk factor for surgery. The purpose of this study was to evaluate the impact of obesity on outcomes after appendectomy. A retrospective study was performed using discharge abstract data obtained from patients with documented body mass index (BMI) undergoing appendectomy for appendicitis (n = 2919). Complications and length of stay for different BMI categories were compared. Obese patients (BMI > 30 kg/m2) had similar rates of perforation (20%) and were as likely to undergo a laparoscopic approach (85%) as nonobese patients. On multivariable and univariate analysis, no significant differences were observed when comparing obese and nonobese patients for the outcomes of length of stay, infectious complications, and need for readmission. On multivariate analysis, laparoscopy predicted lower complication rates and decreased length of stay. In this study, obesity did not significantly impact rates of perforation, operative approach, length of stay, infectious complications, or readmission.

scholarly journals The Application of Internal Suspension Technique in Retroperitoneal Laparoscopic Partial Nephrectomy for Renal Ventral Tumors

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Wenlong Zhong ◽  
Yicong Du ◽  
Lei Zhang ◽  
Xuesong Li ◽  
Cuijian Zhang ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Renal Tumor ◽  
Tumor Resection ◽  
Patient Characteristics ◽  
Tumor Location ◽  
Warm Ischemia ◽  
Laparoscopic Partial Nephrectomy ◽  
Safe Procedure ◽  
Nephrometry Score ◽  
Baseline Characteristics

Objective. To evaluate the feasibility of an internal suspension technique in retroperitoneal laparoscopic partial nephrectomy for the management of renal ventral tumors. Methods. Between January 2013 and July 2016, a total of 145 patients underwent retroperitoneal laparoscopic partial nephrectomy with or without internal suspension technique. For patients who underwent internal suspension technique, the surgeons preserved the external fat of the renal tumor as a suspension traction measure when separating the kidney. Propensity score matching (PSM) was performed according to age, gender, body mass index, tumor size, tumor location, and RENAL nephrometry score. Patient characteristics and intraoperative and postoperative outcomes were compared between the groups. Results. After PSM, 32 patients treated with the internal suspension technique were compared with 32 cases treated without such technique. Baseline characteristics were statistically similar for the cohorts. The use of our new technique resulted in shorter warm ischemia time (WIT: 15.0 versus 19.0 minutes, P=.002) and tumor resection time (4.0 versus 7.5 minutes, P<0.001). The rate of WIT >25 minutes decreased (6.3% versus 25%, P=.04) and the trifecta outcomes were significantly improved (87.5% versus 62.5%, P=.02). Conclusion. Internal suspension technique is a feasible and safe procedure in retroperitoneal laparoscopic partial nephrectomy for renal ventral tumors.

Outcomes of Robotic Partial Nephrectomy for Renal Masses With Nephrometry Score of ≥7

Urology ◽  
2011 ◽  
Vol 77 (4) ◽  
pp. 809-813 ◽  
Author(s):  
Michael A. White ◽  
Georges-Pascal Haber ◽  
Riccardo Autorino ◽  
Rakesh Khanna ◽  
Adrian V. Hernandez ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Robotic Partial Nephrectomy ◽  
Renal Masses ◽  
Nephrometry Score

scholarly journals Versatility and clinical effectiveness of a synthetic sealing hemostatic patch as alternative to parenchyma suturing in laparoscopic partial nephrectomy

2021 ◽  
Author(s):  
Eva Erne ◽  
Stephan Kruck ◽  
Tilman Todenhoefer ◽  
Stefan Aufderklamm ◽  
Bastian Amend ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Surgical Margin ◽  
Operation Time ◽  
Clinical Effectiveness ◽  
Patient Characteristics ◽  
Suture Technique ◽  
Laparoscopic Partial Nephrectomy ◽  
Complication Rates ◽  
Oxidized Cellulose ◽  
Hepatic Surgery

Abstract Background Improvements in laparoscopic partial nephrectomy (LPN) in order to minimize perioperative warm ischemia time (WIT), complications, and consequently patient outcome are desirable. Veriset™ is a ready-to-use hemostatic patch of absorbable oxidized cellulose and hydrogel components that has earlier been implemented in vascular and hepatic surgery. We report our experience using this device in LPN. Methods Patients with a solitary malignant renal mass suspicious for renal cancer underwent LPN with either the use of Veriset™ hemostatic patch (n = 40) or conventional suture technique (n = 40). Patient characteristics, operation time and WIT, postoperative course and complications were recorded retrospectively. Tumor complexity was calculated according to the R.E.N.A.L. score. Outcome was determined according to the “trifecta” criteria (negative surgical margin, WIT < 25 min, no complications within 30 days). Results No significant differences with regard to clinical parameters and median R.E.N.A.L. score (6) were observed between both groups. Operation time (mean 127.1 min vs. 162. 8 min; p = 0.001) and WIT were both lower in the Veriset™ group (14.6 min vs. 20.6 min; p = 0.01). No differences in surgical margins (p = 0.602) and overall complication rates at 30 (p = 0.599) and 90 days (p = 0.611) postoperatively were noticed. The surgical outcome according to “trifecta” was achieved in 65% of patients using Veriset™ and in 57.5% of patients by suture closure, respectively. Conclusion The hemostatic Veriset™ patch can successfully be implemented in LPN. Handling and application appear favorable, thereby reducing operation time and WIT. The present results suggest that the device may represent an alternative to parenchyma suturing in LPN.

scholarly journals A low RENAL Nephrometry Score can avoid the need for the intraoperative insertion of a ureteral catheter in robot-assisted partial nephrectomy

2021 ◽  
Author(s):  
Kenichi Nishimura ◽  
Yuichi Sawada ◽  
Naoya Sugihara ◽  
Keisuke Funaki ◽  
Kanae Koyama ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Operative Time ◽  
Multivariable Analysis ◽  
Japanese Patients ◽  
Background Characteristics ◽  
Robot Assisted ◽  
Ureteral Catheter ◽  
Ischemic Time ◽  
Factors Associated ◽  
Nephrometry Score

Abstract Background: Intraoperative urinary collecting system entry (CSE) in robot-assisted partial nephrectomy (RAPN) may cause postoperative urinary leakage and extend the hospitalization. Therefore, identifying and firmly closing the entry sites are important for preventing postoperative urine leakage. In RAPN cases expected to require CSE, we insert a ureteral catheter and inject dye into the renal pelvis to identify the entry sites. We retrospectively analyzed the factors associated with intraoperative CSE in RAPN and explored the indications of intraoperative ureteral catheter indwelling in RAPN.Methods: Of 104 Japanese patients who underwent RAPN at our institution from August 2016 to March 2020, 101 were analyzed. The patients were classified into CSE and non-CSE groups. The patients’ background characteristics, RENAL Nephrometry Score (RNS) and surgical outcomes were analyzed.Results: Intraoperative CSE was observed in 41 patients (41%). The CSE group had a significantly longer operative time, console time ischemic time, and hospital stay than the non-CSE group. In a multivariable analysis, the N-score (odds ratio [OR]=3.9, P<0.05) and RNS total score excluding the L-score (OR=3.1, P<0.05) were associated with CSE. In a logistic regression analysis, CSE showed a moderate correlation with the RNS total score excluding the L-score (AUC: 0.848, cut-off: 5, sensitivity: 0.83, specificity: 0.73). Conclusion: A ureteral catheter should not be placed in patients with an RNS total score (excluding the L-score) of ≤4.

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