Background Robotic partial nephrectomy (RPN) has a significant morbidity. Nephrometry scores have been described to predict the occurrence of complications. Their usefulness is debated. Objective To evaluate the clinical utility of three nephrometry scores (radius, exophytic/endophytic, nearness, anterior/posterior, location [RENAL], preoperative aspects and dimensions used for an anatomical [PADUA], and simplified PADUA Renal [SPARE]) to predict perioperative outcomes and compare their performance to the simple measurement of tumor size in a large cohort of patients who underwent RPN. Design, setting, and participants We analyzed 1581 consecutive patients who underwent RPN for small renal masses. Outcome measurements and statistical analysis Tumor size, RENAL, PADUA, and SPARE scores were calculated based on preoperative imaging. Correlation between scores, estimated blood loss (EBL), operative time (OT), and warm ischemia time (WIT) were calculated. Logistic regression analyses were performed to identify predictors of overall and major complications. The area under the curve was used to identify models with the highest discrimination. Decision curve analyses determined the net benefit associated with their use. Results and limitations The median age was 62 yr (interquartile range [IQR]: 52–70) and the median tumor size was 35 mm (IQR: 25–47). Postoperative complications were observed in 346 patients (21.9%), including 5.6% of major complications. All scores were significantly correlated with EBL, OT, and WIT. However, correlation coefficients were all Conclusions Tumor size has the same ability as nephrometry scores to predict perioperative outcomes of RPN. Patient summary We evaluated the association between tumor size, nephrometry scores, and perioperative outcomes of robotic partial nephrectomy (RPN). We found that tumor size could predict perioperative outcomes of RPN as well as nephrometry scores.

Predicting Complications After Robotic Partial Nephrectomy: Back to Simplicity.

Background The use of a nephron-sparing surgery for the treatment of localized renal masses is being pushed to more challenging cases. However, this procedure is not devoid of risks, and the Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location (RENAL) and Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classifications are commonly employed in the prediction of complications. Recently, the Simplified PADUA REnal (SPARE) scoring system has been proposed with the aim to provide a more simple system, to improve its reproducibility to predict postoperative risks. Objective We aim to retrospectively validate and compare the proposed new SPARE system in a multi-institutional population. Design, setting, and participants The Transatlantic Robotic Nephron-sparing Surgery (TRoNeS) study group collected data from 737 patients subjected to robot-assisted partial nephrectomy (RAPN) between 2010 and 2016 at three tertiary care referral centers. Of these patients, 536 presented complete demographic and clinical data. Outcome measurements and statistical analysis Renal masses were classified according to the SPARE, RENAL, and PADUA nephrometry scores, and surgical success was defined according to the margin, ischemia, and complication scores. Results and limitations Of 536 patients, 340 were male; the median age was 61 (53–69) yr and preoperative tumor size was 30 (22–43) mm. The margin, ischemia, and complication score was achieved in 399 of cases (74.4%). All three nephrometry scores were significant predictors of surgical outcomes both in univariate and in adjusted multivariate logistic regression model analysis. In accuracy analysis, the area under the curve (AUC) of the SPARE scoring system (0.73) was significantly higher than those of the PADUA (0.65) and RENAL (0.68) nephrometry scores in predicting surgical success. Conclusions The SPARE score appears to be a promising and reliable score for the prediction of surgical outcomes of RAPN, showing a higher accuracy relative to the traditional PADUA and RENAL nephrometry scores. Further, prospective studies are warranted before its introduction in clinical practice. Patient summary The Simplified PADUA REnal (SPARE) score is a reproducible and simple nephrometry score, offering better predictive capabilities of surgical success and complications.

Multi-institutional Retrospective Validation and Comparison of the Simplified PADUA REnal Nephrometry System for the Prediction of Surgical Success of Robot-assisted Partial Nephrectomy.

Combination of holographic imaging with robotic partial nephrectomy for renal hilar tumor treatment

International guidelines suggest the use of anatomic scores to predict surgical outcomes after partial nephrectomy (PN). We aimed at validating the use of Simplified PADUA Renal (SPARE) nephrometry score in robot-assisted PN (RAPN).Three hundred and sixty-eight consecutive RAPN patients were included. Primary endpoints were overall complications, postoperative acute kidney injury (AKI) and TRIFECTA achievement. Secondary endpoint was estimated glomerular filtration rate (eGFR) decrease at last follow-up. Multivariable logistic and linear regression models were used.Of 368 patients, 229 (62%) vs. 116 (31%) vs. 23 (6.2%) harboured low- vs. intermediate- vs. high-risk renal mass, according to SPARE classification. SPARE score predicted higher risk of overall complications (Odds ratio [OR]: 1.23, 95%CI 1.09-1.39; P < 0.001), and postoperative AKI (OR: 1.20, 95%CI 1.08-1.35; P < 0.01). Moreover, SPARE score was associated with lower TRIFECTA achievement (OR: 0.89, 95%CI 0.81-0.98; P = 0.02). Predicted accuracy was 0.643, 0.614 and 0.613, respectively. After a median follow-up of 40 (IQR: 21-66) months, eGFR decrease ranged from -7% in low-risk to -17% in high-risk SPARE.SPARE scoring system predicts surgical success in RAPN patients. Moreover, SPARE score is associated with eGFR decrease at long-term follow-up. Thus, the adoption of SPARE score to objectively assess tumor complexity prior to RAPN may be preferable. 

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

Robotic partial nephrectomy (RPN) has a significant morbidity. Nephrometry scores have been described to predict the occurrence of complications. Their usefulness is debated.To evaluate the clinical utility of three nephrometry scores (radius, exophytic/endophytic, nearness, anterior/posterior, location [RENAL], preoperative aspects and dimensions used for an anatomical [PADUA], and simplified PADUA Renal [SPARE]) to predict perioperative outcomes and compare their performance to the simple measurement of tumor size in a large cohort of patients who underwent RPN.We analyzed 1581 consecutive patients who underwent RPN for small renal masses.Tumor size, RENAL, PADUA, and SPARE scores were calculated based on preoperative imaging. Correlation between scores, estimated blood loss (EBL), operative time (OT), and warm ischemia time (WIT) were calculated. Logistic regression analyses were performed to identify predictors of overall and major complications. The area under the curve was used to identify models with the highest discrimination. Decision curve analyses determined the net benefit associated with their use.The median age was 62 yr (interquartile range [IQR]: 52-70) and the median tumor size was 35 mm (IQR: 25-47). Postoperative complications were observed in 346 patients (21.9%), including 5.6% of major complications. All scores were significantly correlated with EBL, OT, and WIT. However, correlation coefficients were all <0.3, suggesting a weak association. Nephrometry scores and tumor size were significant predictors of overall complications in univariate and adjusted multivariable logistic regression model analysis. However, decision curve analysis demonstrated net benefit of tumor size comparable with all nephrometry scores. Finally, neither nephrometry scores nor tumor size was found to be associated with the risk of major complications.Tumor size has the same ability as nephrometry scores to predict perioperative outcomes of RPN.We evaluated the association between tumor size, nephrometry scores, and perioperative outcomes of robotic partial nephrectomy (RPN). We found that tumor size could predict perioperative outcomes of RPN as well as nephrometry scores. 

Predicting Complications After Robotic Partial Nephrectomy: Back to Simplicity

Background The RENAL (radius [R], exophytic/endophytic [E], nearness to collecting system/sinus [N], anterior/posterior [A], and location relative to polar lines [L]) and the PADUA (preoperative aspects and dimensions used for an anatomical classification) scores help in quantifying tumor complexity However, nephrometry scoring systems have low interobserver variability To simplify and improve score reproducibility, a new Simplified PADUA Renal (SPARE) scoring system was introduced Objective To externally validate the SPARE nephrometry scoring system and to determine its interobserver variability Design, setting, and participants A total of 202 patients were included in the analysis We performed a retrospective analysis of robot-assisted partial nephrectomy (RAPN) cases for a single renal mass performed at a single academic institution during the period 2008–2018 For each renal mass, PADUA, RENAL, and SPARE nephrometry scores were calculated Outcome measurements and statistical analysis Three urology residents (URs), two urology attendings (UAs), two radiology residents (RRs), and one radiology attending (RA) retrospectively reviewed computed tomography scans blinded to clinical outcomes The accuracy of the SPARE nephrometry score in the prediction of any complication (Clavien grade ≥1) was compared with other scoring systems in a univariable and a multivariate fashion The area under the curve (AUC) and kappa statistics were used to assess interobserver variability of the SPARE score Results and limitations The SPARE score was not inferior to the PADUA and RENAL scores (AUC 061, 059, and 057, respectively, p = 043) Patients with intermediate to high SPARE scores had longer operative time (158 vs 135 min, p = 010) and a higher rate of complications (28% vs 14%, p = 0012) Univariable analysis predicting overall complications showed that RRs performed slightly better than URs and UAs using the SPARE score Interobserver agreement was 84% between an RA and an RR (kappa 042), 85% between an RA and a UA (kappa 039), and 85% between an RA and a UR (kappa 045) Conclusions These findings confirm that the SPARE nephrometry scoring system is a reproducible and easy tool offering overall fair interobserver agreement regardless of years of training or type of practice, while maintaining the predictive capabilities of more established nephrometry scores Patient summary In this study, a novel and simple classification system was assessed using a sample of cases from our institution to define surgical complexity renal masses detected on radiological imaging Our findings suggest that this tool can be useful in clinical practice to facilitate the characterization of renal masses and predict the complications of surgical treatment

Simplified PADUA Renal (SPARE) Nephrometry Scoring System: External Validation, Interobserver Variability, and Comparison with RENAL and PADUA in a Single-center Robotic Partial Nephrectomy Series.

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Simplified PADUA Renal (SPARE) Nephrometry Scoring System: External Validation, Interobserver Variability, and Comparison with RENAL and PADUA in a Single-center Robotic Partial Nephrectomy Series.