The Application Of Modified RENAL Score In Transperitoneal And Retroperitoneal Laparoscopic Partial Nephrectomy

Objective: To explore the application value of RENAL nephrometry scoring system and modified RENAL nephrometry scoring system in the transperitoneal and retroperitoneal laparoscopic partial nephrectomy,evaluate the RENAL tumor anatomy by preoperative CT enhanced scan images.Materials and Methods:We collected the Preoperative imaging data,operative data and perioperative data from 50 patients with local RENAL tumors who underwent laparoscopic partial nephrectomy by the same operator in our hospital from April 2015 to January 2016.No obvious lymph nodes,adrenal glands,distant metastasis,no RENAL vein and inferior vena cava tumor thrombus were found in all the patients by preoperative CT enhanced scan images.Patients with hypertension,coronary heart disease and abnormal blood levels of creatinine were excluded,and 38 patients were included in this study(with 14 TLPN and 24 RLPN).Collect the operative time,the warm ischemia time,the body mass index,the complications and the change of hemoglobin before and after surgery.Scored the RENAL tumor anatomy features using the RENAL score system and modified RENAL score System via the preoperative enhanced CT data.Kappa coefficient was used to text the inter-observer variability.Two scoring system was used to choose which approaches is better.Results:(1):The Kappa value of the RENAL score and modified RENAL score both higher than 0.81,a good consistency.(2)In the group of low RENAL score:There was no statistical significance between the surgical approach and the operative time(p=0.249);There was no statistical significance between the surgical approach and the warm ischemia time(p=0.694);There was no statistical significance between the surgical approach and the change of hemoglobin before and after surgery(p=0.569);There was no statistical significance between the surgical approach and the complications(p=0.470).(3)In the group of middle RENAL score: There was statistical significance between the surgical approach and the operative time(p=0.042);There was no statistical significance between the surgical approach and the warm ischemia time(p=0.204);There was no statistical significance between the surgical approach and the change of hemoglobin before and after surgery(p=0.567);There was no statistical significance between the surgical approach and the complications(p=0.453).(4)In the group of low modified RENAL score: There was statistical significance between the surgical approach and the operative time(p<0.001);There was statistical significance between the surgical approach and the warm ischemia time(p<0.001);There was no statistical significance between the surgical approach and the change of hemoglobin before and after surgery(p=0.234);There was no statistical significance between the surgical approach and the complications(p=0.203).(5)In the group of high modified RENAL score: There was statistical significance between the surgical approach and the operative time(p=0.049);There was statistical significance between the surgical approach and the warm ischemia time(p=0.013);There was no statistical significance between the surgical approach and the change of hemoglobin before and after surgery(p=0.493);There was no statistical significance between the surgical approach and the complications(p=0.290).Conclusion: 1.The modified RENAL score compared with RENAL score with consistency,reliability and higher repeatability.2.The RENAL score has little meaning in guiding the surgical approach.3.The modified RENAL score can guide the surgical approach.It’s better to choose RLPN who has a low score of modified RENAL score.Patients has more advantages with TLPN who has a high score of modified RENAL score.But still need to combine with the individual case and the doctor patient’s clinical experience and surgical skills in order to select the appropriate surgical approach.