Simplified PADUA renal (SPARE) nephrometry score validation and long-term outcomes after robot-assisted partial nephrectomy

Comparison of differences in intraoperative blood loss between left-sided and right-sided robot-assisted partial nephrectomy

This study investigates robot-assisted partial nephrectomy for small-diameter renal tumors, specifically focusing on intraoperative blood loss differences between left and right sides. The study, referenced as ROID2114, involved a retrospective analysis of 173 patients who underwent robot-assisted partial nephrectomy for renal tumors at our institution from November 2016 to March 2024. We evaluated the demographic data, operative duration, and blood loss between groups with right-sided and left-sided tumors. Increased blood loss was classified as a 75th percentile threshold of ≥ 200 ml, and multivariate analysis was conducted to identify risk factors associated with elevated blood loss. Among the patients, 93 (53.8%) had right-sided tumors. No significant differences were found in age, operative time, RENAL score, tumor size, body mass index (BMI), MAP score, or surgical approach between the two sides; however, intraoperative blood loss was notably higher on the right side (100 mL) compared to the left (50 mL, p = 0.016). The multivariate analysis identified several factors linked to increased blood loss: extended operative time (≥ 202 min; p = 0.01, odds ratio 2.81, 95% CI 1.26-6.28), larger tumor size (≥ 27 mm; p = 0.04, odds ratio 2.21, 95% CI 1.02-4.81), and right-sided tumors (p = 0.01, odds ratio 2.82, 95% CI 1.28-6.23). Thus, right-sided tumors, longer operative durations, and RENAL scores exceeding 6 are correlated with heightened intraoperative blood loss in robot-assisted partial nephrectomy.

Predicting post-surgical complications using renal scoring systems

Current surgical approaches for renal malignancies primarily rely on qualitative factors such as patient preferences, surgeon experience, and hospital capabilities. Applying a quantitative method for consistent and reliable assessment of renal lesions would significantly enhance surgical decision-making and facilitate data comparison. Nephrometry scoring (NS) systems systematically evaluate and describe renal tumors based on their anatomical features. These scoring systems, including R.E.N.A.L., PADUA, MAP scores, C-index, CSA, and T-index, aim to predict surgical complications by evaluating anatomical and patient-specific factors. In this review paper, we explore the components and methodologies of these scoring systems, compare their effectiveness and limitations, and discuss their application in advancing patient care and optimizing surgical outcomes.

Multivariate analysis of the parameters affecting the choice of surgical treatment for patients with localized renal cell carcinoma (RCC)

OBJECTIVE

to determine the key factors affecting the surgical treatment selection for patients with localized Renal-Cell Carcinoma (RCC) based on clinical and nephrometry data.

MATERIALS AND METHODS

A retrospective cohort study to determine the key factors affecting the surgical treatment on a subset of patients with localized RCC (T1-T2) that underwent surgical treatment at primary investigational center from 2010 to 2017. Primary results were validated on the retrospective dataset of patients treated at high-volume referent center. Validation aimed to test applicability of the predictive model designed during primary analysis. To determine the relationship between the risks of radical or partial nephrectomy, the multivariate predictive modeling method was used.

RESULTS

Based on the analysis, for polary and laterally located tumors, the risk of RN was conditioned only by remaining functioning parenchyma volume (RFPV). The average critical value of RFPV for polar lesions was = 58%; for lateral tumors = 67%. For medial location, the risk of RN only depended on the tumor size. Average critical value of the tumor size in the medial location was = 38mm. Based on the ROC curve comparison, there were no statistically significant differences between the predictive models containing 12 and 3 factors (AUCLin_12 and AUCMLP_3; P = 0.12); thus, the reduced amount of the factor indicators from 12 to 3 did not worsen the model predictive qualities. Designed during primary analysis hypothesis was successfully validated in a referent center on the cohort of 300 patients. Predictive model is characterized by high sensitivity (95.2%) and specificity (95.4%) in selecting patients for partial nephrectomy.

CONCLUSIONS

For the polar and lateral tumor locations, the functioning parenchymal volumes of over 58 and 67% respectively serve as PN indications. However, for the medial lesions, the primary PN indication is a tumor size less than 38 mm.

Selective Clamping for Robot-Assisted Surgical Procedures

Partial nephrectomy, the gold standard treatment for renal tumors, is performed with clamping of the renal arteries, in order to interrupt the blood flowing towards the tumor. However, the temporary interruption of arterial flow may lead to ischemia of the renal parenchyma. Thus, the interruption of the flow should be as short as possible and the clamping should be localized to the arteries flowing towards the tumor only, by implementing the so-called selective clamping. In this paper, we propose a system to automatically provide to the surgeon the optimal clamping points, according to our methods, which allow to minimize the ischemia percentage, thus preserving the health of the remaining renal parenchyma. Moreover, we exploit the algorithm as a planner for a robotic system that, starting from the clamping points automatically computed, emulates the clamping procedure. The overall architecture is validated on different patient's anatomies and using a robotic setup.

Outcomes and Techniques of Robotic-Assisted Partial Nephrectomy (RAPN) for Renal Hilar Masses: A Comprehensive Systematic Review

Background: Robot-assisted partial nephrectomy (RAPN) is increasingly being employed in the management of renal cell carcinoma (RCC) and it is expanding in the field of complex renal tumors. The aim of this systematic review was to consolidate and assess the results of RAPN when dealing with entirely central hilar masses and to examine the various methods used to address the surgical difficulties associated with them. Methods: A thorough literature search in September 2023 across various databases focused on RAPN for renal hilar masses, adhering to PRISMA guidelines. The primary goal was to evaluate RAPN's surgical and functional outcomes, with a secondary aim of examining different surgical techniques. Out of 1250 records, 13 full-text manuscripts were reviewed. Results: Evidence is growing in favor of RAPN for renal hilar masses. Despite a predominance of retrospective studies and a lack of long-term data, RAPN shows positive surgical outcomes and preserves renal function without compromising cancer treatment effectiveness. Innovative suturing and clamping methods are emerging in surgical management. Conclusions: RAPN is a promising technique for managing renal hilar masses in RCC, offering effective surgical outcomes and renal function preservation. The study highlights the need for more long-term data and prospective studies to further validate these findings.

Can Simplified PADUA Renal (SPARE) Nephrometry scoring system help predict renal function outcomes after robot-assisted partial nephrectomy? (UroCCR study 93)

BACKGROUND

The SPARE Nephrometry Score (NS) is described as easier to implement than the RENAL and PADUA NSs, currently more widely used. Our objective was to compare the accuracy of SPARE NS in predicting renal function outcomes following RAPN.

METHODS

A multicentric retrospective study was conducted using French kidney cancer network (UroCCR, NCT03293563) database. All patients included had RAPN for cT1 renal tumors between May 2010 and March 2021. SPARE was compared to RENAL, PADUA and Tumor Size to predict postoperative acute kidney injury (AKI), chronic kidney disease (CKD) upstaging, de novo CKD at 3-6 months follow-up and Trifecta failure. The ability of the different NSs and tumor size to predict renal function outcomes was evaluated using uni- and multivariate logistic regression models.

RESULTS

According to our study criteria, 1171 patients were included. Mean preoperative tumor size and estimated glomerular filtration rate (eGFR) were 3.4±1.4 cm and 85.8 mL/min/1.73 m2. In total, 266 (22.7%), 87 (7.4%), 94 (8%), and 624 (53.3%) patients had AKI, de novo CKD, CKD upstaging, and Trifecta failure, respectively. In multivariate analysis, all three NSs and tumor size were independent predictors of AKI, CKD de novo, CKD upgrade and Trifecta failure. There was no significant difference between all three NS and tumor sizes in predicting renal function outcomes.

CONCLUSIONS

SPARE Score seems to be a valid alternative to predict renal function outcomes after RAPN. Nevertheless, in our study, tumor size was as accurate as NSs in predicting postoperative outcomes and, therefore, seems to be the logical choice for surgical decisions.