Application Value Of "Diameter-wheelbase-pole Distance" Scoring System In Nephron-sparing Surgery

Objective:To compare the clinical value of R.E.N.A.L and diameter-wheelbase(DAP)scoring system in the choice of surgical methods for renal tumors and to predict the perioperative outcome of nephron-sparing surgery.Methods:From January 2015 to June 2018,the medical records of 249 cases of renal tumor patients receiving surgical treatment with complete CT data from Qingdao municipal hospital were retrospectively analyzed,including 126 cases receiving laparoscopic partial nephrectomy(LNSS)and 123 cases receiving laparoscopic radical nephrectomy(LRN).R.E.N.A.L and DAP scoring system were used to score and compare.Chi-square test was used to compare the correlation between the two nephrometry scoring systems and surgical methods,and the ROC curve was used to analyze the evaluation effectiveness of the two scoring systems for the choice of surgical methods.The degree of difficulty of operation was graded according to the results of each score and the criteria of evaluation.The sensitivity,specificity and Yorden index of the two scoring systems for the evaluation of surgical difficulty were compared.Finally,the relationship between the two scoring systems and the operation time,warm ischemia time,creatinine(Cr)difference before and after operation,erythrocyte(RBC)difference before and after operation,postoperative hospitalization time and perioperative outcome of complications were compared.Results:Of 249 patients with renal tumor,121 were male,128 female,123 left kidney and 126 right kidney,with an average age of 56.31±6.02.The results of chi-square test showed that the DAP scoring system(?~2=159.725 p<0.001)and the R.E.N.A.L scoring system(P<0.001)were significantly correlated with the operation mode.he ROC curve was used to analyze the effectiveness of the two scoring systems in evaluating the choice of surgical methods.The area under the ROC curve showed that the DAP scoring system(AUC=0.938)was larger than the R.E.N.A.L score(AUC=0.758)in area under the ROC curve.Radical nephrectomy should be selected when the DAP score is greater than6.5.The actual operation difficulty of 126 patients undergoing LNSS operation was classified as follows:57 cases were low,54 cases were moderate and 15 cases were high.Sensitivity of the R.E.N.A.L scoring system for assessing surgical difficulty(low,moderate,high):70.37%,76.06%,51.85%;Specificity:80.23%,67.29%,98.23%;Yorden index:0.506,0.4335,0.5008.DAP score system sensitivity to surgical difficulty(low,medium,high)assessment:93.44%,90%,78.95%.specificity:93.24%,90%,99.1%;Yorden index:0.86,0.80,0.7806.The clinical effect of the DAP scoring system is more accurate than that of the R.E.N.A.L scoring system.There was a significant correlation between the DAP score system and the time of operation,the time of hot ischemia,the difference of Cr before and after operation,the difference of RBC before and after operation,and the postoperative complications(p<0.05).Conclusion:Compared with the R.E.N.A.L score,the DAP scoring system is more consistent with the surgical characteristics of LNSS.It comprehensively evaluates the characteristics of renal tumors and fully evaluates the difficulty and risk of laparoscopic nephrosparing surgery.The DAP scoring system has a good application value in the prediction of perioperative outcome and is more suitable for clinical application.