R.E.N.A.L nephrometry scoring system for management of solid renal mass

Abstract

INTRODUCTION AND OBJECTIVES: With advances in imaging quality and availability, more renal mass were detected at an early stage. To achieve maximum renal preservation, partial nephrectomy has become the standard for management of small renal mass Decision on partial nephrectomy has been mostly depending on the size of tumor. In order to provide a more objective means to describe the complexity of renal masses in relation to surgery, scoring system has been developed and validated. We investigate the usage of the R.E.N.A.L nephrometry score in relations to the choice of treatment and post-operative complications for renal masses. METHODS: Data of patients undergoing partial or total nephrectomy in a tertiary referral hospital were collected retrospectively from a clinical database and analyzed. R.E.N.A.L nephrometry score was allocated to each renal tumor utilizing computerized imaging systems (GE Advantage Workstations) single blinded by qualified radiologist. Patient demographics, choice of surgery (radical vs partial), approaches (open vs minimally invasive (MIS)) were analyzed with respected to their R.E.N.A.L score. RESULTS: There were together 74 patients included during the study period, of which 38 undergone partial nephrectomy and 36 undergone radical nephrectomy. There were significant differences between the partial and radical nephrectomy group in terms of their mean nephrometry sum (6.89 vs 9.31, P< 0.001). Individual parameter of R.E.N.A.L score were significantly different between two group in terms of radius (P< 0.001), nearest to collecting system (P < 0.001) and locations relative to polar lines (P= 0.017) but not for exophytic component or location (anterior or posterior). The mean nephrometry sum was also significantly different between open approach versus minimal invasive approach in the partial nephrectomy group (7.79 vs 6.00, P= 0.001). There was no difference in post-operative 90 days morbidity and mortality between the two group. CONCLUSIONS: R.E.N.A.L nephromery score of a renal mass has a significant correlations with our choice of surgery and our approach to surgery, particularly in the partial nephrectomy group. It dose not correlate with post-operative complication. Nephrometry score provide a useful tool in objectifying renal mass character and enhance operative planning in the management of renal masses.