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Correlation of the RENAL nephrometry score with warm ischemia time after robotic partial nephrectomy

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Abstract

Purpose

The RENAL nephrometry score (RNS) was developed to quantify complexity of renal tumors in a reproducible manner. We aim to determine whether individual categories of the RNS have different impact on the warm ischemia time (WIT) for patients undergoing robotic partial nephrectomy (RPN).

Methods

In a retrospective analysis of a prospectively maintained database, we identified 251 consecutive patients who underwent RPN between January 2007 and June 2010. RNS was determined in 187 with available imaging. Univariable analysis and multivariable linear regression analysis were performed to identify which factors were more significantly associated with WIT.

Results

Overall RNS was of low (4–6), moderate (7–9), and high complexity (10–12) in 84 (45 %), 80 (43 %), and 23 (12 %) patients, respectively. There was no association between gender (p = 0.6), BMI (p = 0.3), or anterior/posterior location (A) (p = 0.8), and WIT. On univariable analysis, longer WIT was associated with size (R) >4 cm (p < 0.0001), entirely endophytic properties (E) (p = 0.005), tumor <4 mm from the collecting system/sinus (N) (p < 0.0001), and location between the polar lines (L) (p = 0.004). Total RNS and WIT were highly correlated (Spearman correlation coefficient = 0.54, p < 0.0001). There was a significant trend of higher WIT with increased tumor complexity (p for trend <0.0001). After multivariable analysis, only R (p = 0.0003), E (p = 0.003), and N (p = 0.00002) components of the RNS were significantly associated with WIT.

Conclusions

The A and L subcategories of the RNS have no significant impact on the WIT of patients undergoing RPN. WIT is significantly dependent upon the other subcategories, as well as the overall RNS. These findings can be used to preoperatively predict which tumor characteristics will likely affect WIT and may be useful in preoperative counseling as well as planning of approach.

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Abbreviations

RNS:

RENAL nephrometry

WIT:

Warm ischemia time

BMI:

Body mass index

RPN:

Robotic partial nephrectomy

GFR:

Glomerular filtration rate

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Conflict of interest

Dr. Jihad H. Kaouk and Dr. Georges-Pascal Haber are consultant for Intuitive Surgical. This study was not sponsored.

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Authors and Affiliations

  1. Center for Laparoscopic and Robotic Surgery–Urology, Glickman Urology and Kidney Institute, Cleveland Clinic Foundation, 9500, Euclid Avenue, Q10-1, Cleveland, OH, 44195, USA

    Fatih Altunrende, Humberto Laydner, Riccardo Autorino, Rakesh Khanna, Michael A. White, Wahib Isac, Gregory Spana, Shahab Hillyer, Bo Yang, Rachid Yakoubi, Georges-Pascal Haber, Jihad H. Kaouk & Robert J. Stein

  2. Health Outcomes and Clinical Epidemiology, Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, USA

    Adrian V. Hernandez

Authors
  1. Fatih Altunrende
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  2. Humberto Laydner
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  3. Adrian V. Hernandez
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  4. Riccardo Autorino
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  5. Rakesh Khanna
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  6. Michael A. White
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  7. Wahib Isac
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  8. Gregory Spana
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  9. Shahab Hillyer
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  10. Bo Yang
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  11. Rachid Yakoubi
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  12. Georges-Pascal Haber
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  13. Jihad H. Kaouk
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  14. Robert J. Stein
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Corresponding author

Correspondence to Robert J. Stein.

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Altunrende, F., Laydner, H., Hernandez, A.V. et al. Correlation of the RENAL nephrometry score with warm ischemia time after robotic partial nephrectomy. World J Urol 31, 1165–1169 (2013). https://doi.org/10.1007/s00345-012-0867-4

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  • DOI: https://doi.org/10.1007/s00345-012-0867-4

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