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 Elective partial and radical nephrectomy in patients with renal cell carcinoma in CT1B stadium

2021 ◽  
pp. 8-8
Author(s):  
Predrag Maric ◽  
Predrag Aleksic ◽  
Branko Kosevic ◽  
Mirko Jovanovic ◽  
Vladimir Bancevic ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Partial Nephrectomy ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Local Relapse ◽  
Normal Serum ◽  
Cancer Specific Survival ◽  
Tumour Control ◽  
Renal Tumours

Background/Aim. In renal cell carcinoma (RCC) the choice of surgical technique, radical (RN) or partial nephrectomy (PN) is still centre dependant because there still are no absolute recommendations for this approach. This study aims to analyze the oncological aspects, time until recurrent disease appears and cancer-specific survival in patients with RCC in T1bN0?0 depending on the type of surgical procedure partial or radical nephrectomy. Methods. A clinical observational study of a series of cases was conducted that analyzed data of 154 patients operated in our institution with a mean follow up a period not less than five years. The inclusion criteria included: renal tumours 4-7 cm, histopathological confirmation of RCC, absence of metastasis and normal serum creatinine. Exclusion criteria included: the presence of other malignancies, solitary functional kidney or comorbidities that can compromise renal function, bilateral tumours or unilateral multiple tumours. Results. The study analyzed data of 154 patients, 97 radical nephrectomies and 57 patients that underwent partial nephrectomy. Analyzing cancer-specific survival in four patients with RN there was a disease advancement that led to a lethal outcome, one PN patient died as a result of local relapse and distant metastasis. Conclusion. Based on our results PN is a good and safe treatment option for patients with RCC in T1b stadium. Partial nephrectomy offers a similar tumour control and better cancer-specific survival.

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.

External validation of the RENAL nephrometry score in renal tumours treated by partial nephrectomy

2012 ◽  
Vol 111 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Jean-Alexandre Long ◽  
Valentin Arnoux ◽  
Gaelle Fiard ◽  
Riccardo Autorino ◽  
Jean-Luc Descotes ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
External Validation ◽  
Nephrometry Score ◽  
Renal Tumours

Laparoscopic versus open partial nephrectomy for the management of highly complex renal tumors with PADUA score ⩾10: A single center analysis.

2021 ◽  
pp. 039156032110016
Author(s):  
Francesco Chiancone ◽  
Marco Fabiano ◽  
Clemente Meccariello ◽  
Maurizio Fedelini ◽  
Francesco Persico ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Operation Time ◽  
Renal Tumors ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Operative Complications ◽  
Group A ◽  
Group B ◽  
Post Operative Complications

Introduction: The aim of this study was to compare laparoscopic and open partial nephrectomy (PN) for renal tumors of high surgical complexity (PADUA score ⩾10). Methods: We retrospectively evaluated 93 consecutive patients who underwent PN at our department from January 2015 to September 2019. 21 patients underwent open partial nephrectomy (OPN) (Group A) and 72 underwent laparoscopic partial nephrectomy (LPN) (Group B). All OPNs were performed with a retroperitoneal approach, while all LPNs were performed with a transperitoneal approach by a single surgical team. Post-operative complications were classified according to the Clavien-Dindo system. Results: The two groups showed no difference in terms of patients’ demographics as well as tumor characteristics in all variables. Group A was found to be similar to group B in terms of operation time ( p = 0.781), conversion to radical nephrectomy ( p = 0.3485), and positive surgical margins ( p = 0.338) while estimated blood loss ( p = 0.0205), intra-operative ( p = 0.0104), and post-operative ( p = 0.0081) transfusion rates, drainage time ( p = 0.0012), pain score at post-operative day 1 (<0.0001) were significantly lower in Group B. The rate of enucleation and enucleoresection/polar resection was similar ( p = 0.1821) among the groups. Logistic regression analysis indicated that preoperative factors were not independently associated with the surgical approach. There was a statistically significant difference in complication rate (<0.0001) between the two groups even if no significant difference in terms of grade ⩾3 post-operative complications ( p = 0.3382) was detected. Discussion: LPN represents a feasible and safe approach for high complex renal tumors if performed in highly experienced laparoscopic centers. This procedure offers good intraoperative outcomes and a low rate of post-operative complications.

Partial Nephrectomy Is Associated with Improved Overall Survival Compared to Radical Nephrectomy in Patients with Unanticipated Benign Renal Tumours

2010 ◽  
Vol 58 (2) ◽  
pp. 293-298 ◽  
Author(s):  
Christopher J. Weight ◽  
Gregory Lieser ◽  
Benjamin T. Larson ◽  
Tianming Gao ◽  
Brian R. Lane ◽  
...  
Keyword(s):  
Overall Survival ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Renal Tumours

The Application of R.E.N.A.L. Nephrometry Score In Laparoscopic Partial Nephrectomy With Zero Ischemia And Sutureless

2021 ◽  
Author(s):  
Yi Mu ◽  
Kehang Chen ◽  
Jun He ◽  
Peng Chen ◽  
Miao Liu ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Renal Artery ◽  
Cell Carcinoma ◽  
Partial Nephrectomy ◽  
Renal Cell ◽  
Artery Occlusion ◽  
Nephrometry Score ◽  
Renal Artery Occlusion ◽  
Zero Ischemia

Abstract Background: To evaluate the application of R.E.N.A.L. nephrometry score (RNS) in laparoscopic partial nephrectomy (LPN) with zero ischemia and sutureless surgery, and to explore the efficacy and safety of zero ischemia and seamless LPN in the treatment of renal cell carcinoma.Methods: The clinical data of 67 patients with renal cell carcinoma treated by LPN in the affiliated Hospital of Guizhou Medical University from January 2016 to July 2020 were analyzed retrospectively. The patients were divided into renal artery occlusion group (n=31) and non-occlusion group (n=36). All cases were divided according to their RNS (low, moderate, and high), and the perioperative condition, postoperative complications, postoperative recovery and changes of renal function in the two groups were analyzed.Results: According to the RNS, all cases were classified in low-complex. Both groups successfully completed the operation without operative complications. Compared with the renal artery occlusion group, the non-occlusion group had a shorter operation time (35.51±20.48 min), shorter hospital stay (6.72±4.39 d), and no significant difference in intraoperative blood loss(50.39±30.19 ml). During the 6-month follow-up, the creatinine value of the renal function in the non-occlusion group (78.47±10.98μmol/L) was lower than that in the occlusion group(98.21±8.06μmol/L).Conclusion: Zero-ischemia sutureless LPN technique can effectively reduce the time of ischemia and avoid renal ischemia-reperfusion injury. This surgical technique may be a feasible surgical method for the treatment of low RNS renal cell carcinoma.

Phase I/II trial of dexverapamil plus vinblastine for patients with advanced renal cell carcinoma.

1995 ◽  
Vol 13 (8) ◽  
pp. 1958-1965 ◽  
Author(s):  
R J Motzer ◽  
P Lyn ◽  
P Fischer ◽  
P Lianes ◽  
R L Ngo ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Plasma Concentrations ◽  
Advanced Renal Cell Carcinoma ◽  
Reversal Agent ◽  
Group A ◽  
Group B ◽  
Mdr Reversal

PURPOSE The reduced cardiac toxicity of the dextro-(d-) stereoisomer of verapamil (dexverapamil; Knoll Pharmaceuticals, Whippany, NJ) warrants its study as a potential multidrug-resistance (MDR) reversal agent. PATIENTS AND METHODS Twenty-three patients with advanced renal cell carcinoma (RCC) were treated with vinblastine at a dose of 0.11 mg/kg intravenous (IV) bolus injection on days 1 and 2 every 21 days. Dexverapamil was added to subsequent cycles after resistance had been demonstrated. Dexverapamil treatment was begun 18 hours before day 1 of vinblastine administration and was given orally every 6 hours for 12 doses. Patients in group A were treated with a dose of 120 mg/m2, and those in group B were treated with 180 mg/m2 plus dexamethasone; plasma concentrations achieved in patients were correlated with in vitro effects. RESULTS Toxicities included hypotension, asymptomatic bradycardia, and mild atrioventricular conduction delays, although one patient had dexverapamil discontinued for grade IV congestive heart failure. There were no partial or complete responses. The mean day-1 serum dexverapamil plus norverapamil plasma concentrations were 2,575 ng/mL (range, 697 to 6,015 ng/mL) for group A and 1,654 ng/mL (range, 710 to 4,132 ng/mL) for group B at the time of vinblastine administration. These concentrations were in the range of those that reversed vinblastine resistance in vitro. CONCLUSION The advantage of dexverapamil as an MDR reversal agent is its potential for achieving desired blood levels with substantially less toxicity than the racemic mixture of verapamil. Based on tolerability, it is a suitable drug for further study in clinical trials of malignancies other than RCC that attempt to achieve MDR reversal. The dose of 120 mg/m2 given orally every 6 hours, with dose escalation based on individual tolerance, represents a feasible schedule to be considered for such studies.

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