Construction and application of a three-dimensional vascular variation-based nephrometry scoring system for completely endophytic renal tumors

Background:Completely endophytic renal tumors(CERT)pose significant challenges due to their anatomical complexity and loss of visual clues about tumor location.A facile scoring model based on three-dimensional(3D)reconstructed images will assist in better assessing tumor location and vascular variations.Methods:In this retrospective study,80 patients diagnosed with CERT were included.Forty cases underwent preoperative assessment using 3D reconstructed imaging(3D-Cohort),while the remaining 40 cases were assessed using two-dimensional imaging(2D-Cohort).Vascular variations were evaluated by ascertaining the presence of renal arteries>1,prehilar branching arteries,and arteries anterior to veins.The proposed scoring system,termed RAL,encompassed three critical components:(R)adius(maximal tumor diameter in cm),(A)rtery(occurrence of arterial variations),and(L)ocation relative to the polar line.Comparison of the RAL scoring system was made with established nephrometry scoring systems.Results:A total of 48(60%)patients exhibited at least one vascular variation.In the 2D-Cohort,patients with vascular variations experienced significantly prolonged operation time,increased bleeding volume,and extended warm ischemia time compared with those without vascular variations.Conversely,the presence of vascular vari-ations did not significantly affect operative parameters in the 3D-Cohort.Furthermore,the 2D-Cohort demon-strated a notable decline in both short-and long-term estimated glomerular filtration rate(eGFR)changes com-pared with the 3D-Cohort,a trend consistent across patients with warm ischemia time≥25 min and those with vascular variations.Notably,the 2D-Cohort exhibited a larger margin of normal renal tissue compared with the 3D-Cohort.Elevated RAL scores correlated with larger tumor size,prolonged operation time,extended warm is-chemia time,and substantial postoperative eGFR decrease.The RAL scoring system displayed superior predictive capabilities in assessing postoperative eGFR changes compared with conventional nephrometry scoring systems.Conclusions:Our proposed 3D vascular variation-based nephrometry scoring system offers heightened proficiency in preoperative assessment,precise prediction of surgical complexity,and more accurate evaluation of postoper-ative renal function in CERT patients.

Role of R.E.N.A.L.Nephrometry Score in Laparoscopic Partial Nephrectomy

Background：Preoperative anatomical scoring system is conducive to comparison between treatment options and evaluation of postoperative outcomes in patients with small renal tumors.This study aimed to evaluate the clinical application efficacy of the R.E.N.A.L.nephrometry score （RNS） in predicting perioperative outcomes in patients with renal tumor who underwent laparoscopic partial nephrectomy （LPN）.Methods：The clinical data of 139 patients with renal tumors who underwent LPN between 2009 and 2015 were collected and analyzed.Patients were divided into three groups according to their RNS （low,moderate,and high）.Clinical characteristics including perioperative variables,complications,and RNS were compared to evaluate the differences between the three groups.Multivariable logistic regression analysis was used to analyze the risk factors of postoperative complications.Results：According to the RNS,there were 74,50,and 15 patients in the low,moderate,and high RNS groups,respectively.There were significant differences in estimated blood loss （EBL;χ^2 =7.285,P =0.026）,warm ischemia time （WIT;χ^2 =13.718,P =0.001）,operation time （OT;χ^2 =6.882,P =0.032）,perioperative creatinine clearance change （PCCC;χ^2 =6.206,P =0.045）,and number of patients with complications （NPC;P =0.002） among the three groups.The values for EBL,WIT,OT,PCCC,and NPC for patients in the high RNS group were higher than those for patients in the low RNS group.After adjustment for OT,WIT,and EBL,RNS was statistically significantly associated with the risk of postoperative complications in a multivariable logistic regression model （odds ratio =1.541,95% confidence interval：1.0592.242,P =0.024）.Conclusions：The RNS is a valuable tool for evaluating the complexity of renal tumor anatomy.It can aid surgeons in preoperative decision-making concerning management therapy.Future multicenter,large sample size studies are warranted for evaluating its predicting performance of perioperative outcomes.