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. 2017;70(3):232-237.
doi: 10.5173/ceju.2017.1331. Epub 2017 Jun 29.

External validation of four nephrometry scores for trans-peritoneal robotic partial nephrectomy

Bhavan Prasad Rai  1 , Amit Patel  2 , Ahmed Abroaf  1 , Narin Suleyman  1 , Shanmugasundaram Gowriemohan  3 , Venkat Prasad  3 , Nikhil Vasdev  1 , Jim Adshead  1
Affiliations

External validation of four nephrometry scores for trans-peritoneal robotic partial nephrectomy

Bhavan Prasad Rai et al. Cent European J Urol. 2017.

Abstract

Introduction: External validation of four nephrometry scores (NS): Centrality index (C-index), arterial based complexity (ABC), preoperative aspects and dimensions used for an anatomical (PADUA) and radius expohytic/endophytic nearness anterior/posterior location (RENAL) scoring systems in patients who have undergone trans-peritoneal robotic assisted partial nephrectomy (RAPN).

Material and methods: A prospective database for RAPN has been maintained. Individual NSs were performed on 3-dimensional reconstructions of MDCT/MRI studies retrospectively by a board certified uroradiologist. Univariate Cox Proportional-Hazard Regression Analysis was performed for each NSs to valuate its predictability for the following parameters: Warm Ischemia Time (WIT), Estimated Blood Loss (EBL), Operative Time (OT), Complication Rates and Positive Margin Rates.

Results: 78 RAPNs were performed for suspected renal malignancies. The mean OT, EBL and WIT time was 186.5 minutes (SD - 33.8), 125.5 mls (SD - 188.91) and 16.7 minutes (SD - 5.6) respectively. The overall complication rate was 20.5% (16/78) of which only 2.6% (2/78) were Clavien Grade 3 or higher complications. The mean change in creatinine change at Day - 1 was 12.54 μmol/L (SD - 18.05). On the Cox regression analysis only the Centrality index predicted prolonged WIT with statistical significance: C-Index (0.02), ABC (0.2), PADUA (0.2), RENAL (0.9). ABC predicted operative time with statistical significance: C-index (0.45), ABC (0.0004), PADUA (0.25), RENAL (0.3). None of the NSs could predict overall complication: C-index (0.5), ABC (0.2), PADUA (0.13), RENAL (0.5). None of the NSs predicted EBL: C-index (0.3)0, ABC (0.8), PADUA (0.2), RENAL (0.7). None of the NSs predicted Positive Margin Rates: C-index (0.4), ABC (0.4), PADUA (0.9), RENAL (0.8).

Conclusions: C-index was able to predict prolonged WIT. ABC was a strong predictor of OT. PADUA and RENAL were poor predictors for all measured parameters.

Keywords: ABC; PADUA; centrality index; nephrometry scores; renal; robotic assisted partial nephrectomy.

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Figures

Figure 1
Figure 1
Cox regression analysis – Centrality index (C-index) predicted prolonged warm ischemia time (WIT).
Figure 2
Figure 2
Cox regression analysis – Arterial based complexity (ABC) predicted operative time.
See this image and copyright information in PMC

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