Significance Of The Way Of The Nephron-sparing Surgery Surgical Treatment In Renaltumour By The R.E.N.A.L Nephrometry Scoring System

Objectives: To discuss the significance of R.E.N.A.L nephrectomy scoring system in choosing suitable surgery method and evaluate its clinical value.Methods and Materials: A total of189patients underwent partial nephrectomy in the First Affiliated Hospital of Fujian Medical University from January2011to June2013were enrolled in the retrospective analysis, among which71cases underwent open partial nephrectomy while118cases underwent laparoscopic partial nephrectomy. We scored preoperative imaging data (CT/MRI) of patients in this research by R.E.N.A.L nephrectomy scoring system, used chi-square test to compare relationships of different scoring grade with operative duration, bleeding volume during surgery, warm ischemia time, serum creatinine changes and postoperative hospital stay respectively, and analyzed correlations between surgical options and scoring items of R.E.N.A.L, to find out the major factors in surgical options.Results: The results showed significant difference of R.E.N.A.L scoring system with warm ischemia time (P<0.001), operative duration (P=0.006), bleeding volume during surgery (P=0.032) and glomerular filtration rate (P=0.009), while there were no significance between R.E.N.A.L scoring system and serum creatinine change (P=0.419) as well as postoperative hospital stay (P=0.933). In high-complexity group, warm ischemia time in open partial nephrectomy was shorter than in the laparoscopic one (P=0.047), surgical options were significantly correlated with greatest tumor diameter (R)(P=0.035) and tumor location which developed along vertical axis of kidney (P=0.029) while has no significance with bulging rate, distance between tumor and renal sinus, and tumor location.Conclusions: R.E.N.A.L nephrectomy scoring system gives guidance to partial nephrectomy, enabling us to estimate bleeding volume during surgery, operative duration and warm ischemia time. R.E.N.A.L nephrectomy scoring system showed that open partial nephrectomy was a better surgical option for high-complexity cases.