比較R.E.N.A.L.分數和PADUA分類對於
大於4公分腎臟腫瘤接受微創手術之術後相關預後因子
麥倖嘉1、吳俊賢1,2,3、凌永耀1、吳振宇1、林嘉祥1,4
1義大醫院 泌尿科；2義守大學醫學院護理學系醫學系
3義守大學化學工程學系暨生物科技與化學工程研究所
4義守大學醫學院醫學系
Using R.E.N.A.L. nephrometry and PADUA classification to evaluate
perioperative outcomes in renal tumor beyond 4cm
underwent minimally invasive partial nephrectomy in a single center
Hsing-Chia Mai 1、Chun-Hsien Wu 1,2,3、Yung-yao Lin1、Richard C. Wu1、Victor C. Lin 1,4
1. Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
2. Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering,
I-Shou University, Kaohsiung, Taiwan
3. Department of Nursing, I-Shou University, Kaohsiung, Taiwan
4. School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
Purpose: The R.E.N.A.L. and PADUA nephrometry scoring system are frequently used in predicting perioperative outcomes after nephron-sparing surgery (NSS). Since performing minimal invasive NSS on renal masses beyond 4 cm in diameter remains challenging and may result in significant complications, we aim to evaluate the predictive value of these scoring systems for minimal invasive NSS on renal masses beyond 4 cm.
Materials and Methods: From January 2008 to March 2019, we retrospectively reviewed the cases who underwent partial nephrectomy. Robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) for renal tumor > 4 cm at our institution. CT or MRI were the standard cross image before surgery, and the R.E.N.A.L. and PADUA score was reviewed and calculated accordingly. The correlation between the two systems and the perioperative and renal function outcomes were calculated and analyzed.
Results: A total of 93 cases were enrolled in this study. The mean age was 54 years old. The mean tumor size was 6.1±2.03 cm. R.E.N.A.L. score showed significant correlation with warm ischemia time (WIT) (r=0.267,p =0.021), hospital stay (r=0.258, p =0.013) and renal functional outcome at one year (r=0.421, p =0.003) while PADUA score showed higher correlation in operation time (r=0.255, p =0.014), WIT (r=0.278, p =0.016) and renal function at one year (r=0.615, p <0.001). Both score systems did not correlate with Estimated blood loss (p=0.510 and 0.5466, respectively). R.E.N.A.L., PADUA score, age (p=0.962), BMI, Charlson comorbidity index, tumor size, and ASA score did not associate with surgical complications in univariate regression analysis in the present study.
Conclusions: Both the R.E.N.A.L. and PADUA scoring systems were associated with WIT and renal functional outcome, and PADUA score system was more relevant. When performing minimal invasive NSS on renal masses beyond 4 cm, both systems can provide valuable risk stratification, and PADUA seems to be superior in the current study.