scholarly journals R.E.N.A.L. Nephrometry Score Profile of Kidney Cancer Patients in Cipto Mangunkusumo Hospital

2019 ◽  
Vol 13 (3) ◽  
pp. 75
Author(s):  
Rinto Hariwibowo ◽  
Agus Rizal AH Hamid ◽  
Chaidir Arif Mochtar
Keyword(s):  
Cancer Patients ◽  
Partial Nephrectomy ◽  
Kidney Cancer ◽  
Scoring Systems ◽  
Low Complexity ◽  
High Complexity ◽  
Nephrometry Score ◽  
System A ◽  
Posterior Position ◽  
Collecting System

Background: The variation of sizes, shapes, and location of kidney cancer complicates the choices of surgical treatment.To determine which technique to use, R.E.N.A.L. nephrometry scoring systems were established. This study was conducted to evaluate R.E.N.A.L.-NS profile in kidney cancer patients at CMHMethod: The data were collected retrospectively from patients that underwent both open and laparoscopic Radical (RN) and Partial Nephrectomy (PN) procedure from 2014-2017. R.E.N.A.L.-NS was calculated based on (R)adius, (E)xophytic/ Endophytic properties, (N)earness to the collecting system, (A)nterior or Posterior position of the tumor, and (L)ocation of the tumor. It was categorized into three complexity: low (4-6 points), medium (7-9 points), and high (10-12 points). Subjects then divided based on the procedure given. Profile of R.E.N.A.L.-NS was shown based on each procedure.Result: In this study, 63 patients were included. 52 underwent RN and 11 underwent PN. In low complexity tumors, all patients received PN. In medium complexity tumors, 22 (78.5%) patients received RN and 6 (21.5%) received PN. All high complexity tumors received RN. Mean renal score in all patient 9.03 (+1.72), RN 9.59 (+1.11), PN 6.36 (+1.6). Higher (R), (N), and (L) scores mean a higher prevalence of RN.Conclusion: Higher complexity tumors were more likely to be treated with RN. Furthermore, (R), (N), and (L) score can be useful to determine RN or PN as a treatment of choice. This study could be used as a reference to another study regarding R.E.N.A.L.-NS in Indonesia.

Modified R.E.N.A.L nephrometry score for predicting the outcome following partial nephrectomy

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Mohammed Salah ◽  
Mohammed S. ElSheemy ◽  
Waleed Ghoneima ◽  
Mahmoud Abd El Hamid ◽  
Ayman Kassem ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Scoring Systems ◽  
Clinical Staging ◽  
High Complexity ◽  
Prediction Of Outcome ◽  
Perioperative Outcome ◽  
Renal Masses ◽  
Complexity Level ◽  
Nephrometry Score

Abstract Background It was difficult to compare the outcome of partial nephrectomy among different studies due to the absence of standardized description of different renal masses. This problem led to the development of nephrometry scoring systems. R.E.N.A.L. is among the commonest nephrometry scoring systems; however, some studies failed to find any relation between R.E.N.A.L. with perioperative outcome. We evaluated our designed newly modified nephrometry score in prediction of outcome following partial nephrectomy and compared its predictability versus original R.E.N.A.L. Methods Fifty-one patients with cT1-2N0M0 renal masses amenable for partial nephrectomy were included prospectively. Different perioperative outcome variables were compared according to complexity level in R.E.N.A.L. and the newly modified nephrometry score. Results Clinical staging was T1a (21.6%), T1b (49%), T2a (25.5%), T2b (3.9%). Median R.E.N.A.L. was 9 (4–12). Hilar position and intrarenal pelvis were detected in 19.6% and 68.6%. Low, moderate and high complexity masses were found in 21.6%, 39.2% and 39.2%. Complications and rate of conversion to radical nephrectomy were 17 (33.3%) and 4 (7.8%). The only significantly affected variable (p = 0.039) by R.E.N.A.L. was rate of secondary intervention, but it was higher in low than in high complexity level. In the newly modified nephrometry score, complications (p = 0.037) and rate of positive surgical margin (p = 0.049) were significantly higher with increased complexity level. Although other variables (pelvi-calyceal system entry, operative time, blood loss, hemoglobin loss, blood transfusion and conversion to radical nephrectomy) did not show statistically significant difference according to both scores, they were better associated with the complexity level in the newly modified nephrometry score with their remarkable increase in the high when compared to the low complexity level. Conclusions The newly modified nephrometry score was associated with better prediction of outcome of partial nephrectomy when compared to R.E.N.A.L.

PREDICTABILITY OF RENAL NEPHROMETRY SCORING IN DETERMINING TYPE OF SURGICAL APPROACH IN THE TREATMENT OF LOCALIZED RENAL TUMOURS : A SINGLE TERTIARY CENTER EXPERIENCE.

2021 ◽  
pp. 36-38
Author(s):  
Jitendra Kumar Barad ◽  
Raghuveer Pedamallu ◽  
Rahul Devraj ◽  
Ram Reddy. Ch
Keyword(s):  
Partial Nephrectomy ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Individual Component ◽  
Scoring Systems ◽  
Nephrometry Score ◽  
Renal Tumours ◽  
Group A ◽  
Group B ◽  
Component Scores

Background: Partial nephrectomy became more preferred option in the treatment of localized small renal tumours due to recent advances in imaging modalities and surgical techniques. Renal scoring systems are known to compliment urologist in aiding surgical decision process on extent of surgery in small localized renal tumours. There are few scoring systems described in the literature with their own limitations. Methods: This is a retrospective study of patients with localized renal cell tumours who underwent nephrectomy at Nizam Institute of Medical Sciences (NIMS), Hyderabad fromJanuary 2017 to January 2019. Patients with advanced renal cell cancer disease at presentation were excluded. Total RENAL nephrometry Score (RNS), its individual component scores and complexity category were calculated based on CT report. The study cases were categorized into Group A (Partial Nephrectomy) and as Group B (Radical Nephrectomy). Mean and standard deviation value of the RENAL nephrometry scores and its component scores were calculated for each group. Statistical signicance was calculated using unpaired T-test, using SPSS statistics 21.0 software. Results: The mean age for all patients included in this study is 52.1 years. Out of 80 patients, 32 patients had partial nephrectomy (Group A) and 48 patients had radical nephrectomy (Group B). Based on RENAL nephrometry score complexity, Group A and Group B were further categorized into low, intermediate and high complexity score categories. The total RENAL score, individual component scores and RENAL score complexity were found to be signicantly different between the two group in addition to the tumor size. No statistical signicance was found between the two groups for age and type of tumour on histopathology (benign or malignant). Conclusion: We conclude that preoperative RENAL nephrometry scoring is a useful aid to surgeons to classify the renal tumour complexity before deciding on effective surgical strategy for better patient outcomes

scholarly journals Polyethylene glycol-coated collagen patch (hemopatch®) in open partial nephrectomy

2021 ◽  
Author(s):  
Michael Staehler ◽  
S. Rodler ◽  
M. Schott ◽  
J. Casuscelli ◽  
C. Stief ◽  
...  
Keyword(s):  
Renal Function ◽  
Polyethylene Glycol ◽  
Blood Loss ◽  
Partial Nephrectomy ◽  
Low Complexity ◽  
High Complexity ◽  
Open Partial Nephrectomy ◽  
Duration Of Surgery ◽  
Coated Collagen

Abstract Purpose To describe the results of a polyethylene glycol-coated collagen patch, Hemopatch® on blood loss, surgical time and renal function in partial nephrectomy (PN) for renal cell carcinoma (RCC). Methods Out of a single surgeon cohort of n = 565 patients undergoing conventional open PN (CPN) between 01/2015 and 12/2017 at the University of Munich a consecutive subgroup (n = 42) was operated on using a polyethylene glycol-coated collagen-based sealant Hemopatch® (Baxter International Inc., Deerfield, IL, USA) (HPN). Results Median age was 65.2 years (range 12.7–95.2) with median follow-up of 9.43 months (0.03–49.15). Baseline renal function (CKD-EPI) was 78.56 ml/min/1.73 m2 (range 20.38–143.09) with a non-significant decline to 74.78 ml/min/1.73 m2 (range 3.75–167.74) at follow-up. In CPN 46% had low complexity, 33% moderate complexity and 20% high complexity lesions with 33% low, 40% moderate and 27% high complexity masses in HPN. Median tumor size was 4.3 cm (range 1–38 cm) in CPN with 4.8 cm (range 3.8–18.3 cm) with HPN, p = 0.293. Median blood loss and duration of surgery was significantly lower in the HPN group vs. CPN (146 ml ± 195 vs. 114 ml ± 159 ml; p = 0.021; 43 min ± 27 for HPN vs. 53 min ± 49; p = 0.035) with no difference in clamping time (12.6 min ± 8.6 for HPN vs. 12.0 min ± 9.5; p = 0.701). Conclusions Hemopatch® supported renoraphy shows promising results compared to standard renoraphy in PN. No side effects were seen. Further studies should evaluate the prevention of arterio-venous or urinary fistulas. In complex partial nephrectomies Hemopatch® supported renoraphy should be considered.

Likelihood of high volume renal surgeons to offer elective partial nephrectomy in high complexity tumors as classified by the nephrometry scoring system.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 354-354
Author(s):  
C. J. Weight ◽  
S. P. Kim ◽  
P. L. Crispen ◽  
R. H. Breau ◽  
S. A. Boorjian ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Scoring System ◽  
Radical Nephrectomy ◽  
High Volume ◽  
Low Complexity ◽  
Surgical Volume ◽  
High Complexity ◽  
Renal Masses ◽  
Clinical Scenarios ◽  
Low Volume

354 Background: Partial nephrectomy (PN) has demonstrated equivalent cancer control to radical nephrectomy (RN) and has been associated with lower rates of all-cause mortality. Nevertheless, there continues to be wide variability in practice pattern in the treatment of renal masses. Specifically, the decision to perform PN or RN often depends on patient, surgeon and renal mass characteristics. By quantifying the renal tumor using the R.E.N.A.L. nephrometry scoring system, collecting surgeon information, and providing defined clinical scenarios we attempt to evaluate factors important in surgeon decision-making. Methods: In June 2009, all members of the American Urological Association with a listed email address were invited to participate in a survey evaluating the management of renal masses. Respondents were asked their preferred treatment for 8 clinical scenarios. Each of these renal masses was given a nephrometry score (NS). The propensity to offer PN was evaluated by NS and surgical volume. High volume was defined as > 50 renal cases per year and low volume was defined as £ 10 cases per year. Results: 764 attending level urologic surgeons responded to each of the 8 scenarios providing 6112 evaluable clinical scenarios. NS ranged from 4-10; each unit increase was associated with 2-fold increased odds of a surgeon offering radical nephrectomy (OR 1.99, 95% CI: 1.93,2.06). PN was the preferred treatment for approximately 95% of patients with low complexity tumors (NS < 8) regardless of surgical volume. However, proposed treatment of high complexity tumors (NS ³ 8) demonstrated considerable heterogeneity in treatment choice. Controlling for all patient characteristics, high surgical volume significantly predicted whether PN would be offered to patients with high complexity tumors (OR 3.04 95% CI: 2.34,9.95), but not those with low complexity tumors (OR 1.95 95% CI: 0.87,4.38) compared to low volume surgeons. Conclusions: Increasing NS correlated with increased use of radical nephrectomy, particularly after a score of 8 among all surgeons. As renal surgical volume increased, surgeons were more willing to offer PN in high complexity tumors. No significant financial relationships to disclose.

scholarly journals The association between renal tumour scoring systems and ischemia time during open partial nephrectomy

2013 ◽  
Vol 7 (3-4) ◽  
pp. e207-14 ◽  
Author(s):  
Luke T. Lavallée ◽  
Darren Desantis ◽  
Fadi Kamal ◽  
Brian Blew ◽  
James Watterson ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Scoring Systems ◽  
Renal Tumour ◽  
Smoking History ◽  
Widespread Application ◽  
Open Partial Nephrectomy ◽  
Ischemia Time ◽  
Tumour Characteristics ◽  
Collecting System ◽  
Anterior Posterior

Objective: To evaluate the association between renal tumour scoring systems and open partial nephrectomy ischemia time.Methods: A historical cohort of open partial nephrectomy patients at The Ottawa Hospital between 2002 and 2009 was reviewed. Preoperative patient characteristics (age, gender, preoperative renal function, diabetes, hypertension, smoking history, heart disease) and ischemia time were abstracted from medical records. Preoperative computed tomography (CT) images were reviewed and tumours were characterized using three scoring systems: (1) R.E.N.A.L. nephrometry score (radius, exophytic/endophytic properties, nearness of tumour to the collecting system or sinus in millimetres, anterior/posterior, location relative to polar lines); (2) preoperative aspects and dimensions used for anatomic (PADUA) classification; and (3) Centrality index (C index). Patients without preoperative CT and patients treated with laparoscopic partial nephrectomy were excluded.Results: During the study period, 78 patients met the inclusion criteria. Median R.E.N.A.L. score was 7 (interquartile range [IQR] 5-8), median PADUA score was 8 (IQR 7-10), and mean C index was 3.9 (standard deviation [SD] 2.1). Mean ischemia time was 23.4 (SD 10.8) minutes. Five individual tumour characteristics (diameter, nearness to collecting system, anterior/posterior location, medial/lateral location, and collecting system involvement) were strongly associated with ischemia time (p < 0.05). Increased R.E.N.A.L. score (1.5 minutes per unit 95%CI 0.08, 2.9, p = 0.04) and PADUA score (2.0 minutes per unit 95%CI 0.5, 3.5, p = 0.009) were significantly associated with ischemia time. An increasing C index score was also associated with ischemia time (-1.1 minutes per unit 95%CI -2.2, 0.04, p = 0.06), but the association was not statistically significant.Conclusion: Renal tumour characteristics are associated with ischemia time. The proposed scoring systems are useful descriptors of surgical complexity and should be used when describing partial nephrectomy patients. Prospective evaluation and refinement of scoring systems are required to create an optimized model prior to widespread application.

scholarly journals Stone Formation from Nonabsorbable Clip Migration into the Collecting System after Robot-Assisted Partial Nephrectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Ziho Lee ◽  
Christopher E. Reilly ◽  
Blake W. Moore ◽  
Jack H. Mydlo ◽  
David I. Lee ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Stone Formation ◽  
Renal Calculus ◽  
Laser Lithotripsy ◽  
Robot Assisted ◽  
System A ◽  
Flexible Ureteroscope ◽  
Tomography Scan ◽  
Left Middle ◽  
Collecting System

We describe a case in which a Weck Hem-o-lok clip (Teleflex, Research Triangle Park, USA) migrated into the collecting system and acted as a nidus for stone formation in a patient after robot-assisted partial nephrectomy. The patient presented 2 years postoperatively with left-sided renal colic. Abdominal computed tomography scan showed a 10 millimeter renal calculus in the left middle pole. After using laser lithotripsy to fragment the overlying renal stone, a Weck Hem-o-lok clip was found to be embedded in the collecting system. A laser fiber through a flexible ureteroscope was used to successfully dislodge the clip from the renal parenchyma, and a stone basket was used to extract the clip.

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 COMPARISON OF NEPHROMETRIC SYSTEMS IN PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA

2017 ◽  
Vol 25 (1) ◽  
pp. 110-117
Author(s):  
T V. Shatylko ◽  
V M. Popkov ◽  
A Yu. Korolev ◽  
D A. Chausovsky
Keyword(s):  
Chronic Kidney Disease ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
De Novo ◽  
Low Complexity ◽  
High Complexity ◽  
Total Operative Time ◽  
Ischemia Time ◽  
Time Required ◽  
Kidney Resection

Evaluation of efficacy of using nephrometry scores was performed on our own cohort of patients. Correlation between them and clinical variables was studied. All nephrometry scores - RENAL, PADUA and C-index - correlate significantly with ischemia time during partial nephrectomy, but not with total operative time. Kidney resection for intermediate and high complexity tumors caused chronic kidney disease (CKD) de novo or CKD upstaging more often than resection for low complexity tumors. Low complexity tumors on RENAL and PADUA were characterized by significantly lower renal parenchyma ischemia time required for resection. Complications of partial nephrectomy were observed only in groups with intermediate and high tumor complexity, while differences between intermediate and high complexity seemed practically insignificant. Nephrometry systems are useful in clinical practice, but require further improvement.

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