Study On RENAL Scoring Assists The Surgical Approach Selection In Nephron-sparing Surgery For Renal Tumour

Research background and purpose:To explore the value of R.E.N.A.L scoring system in the selection of surgical approach for the treatment of renal tumors by Da Vinci robot-assisted laparoscopy partial nephrectomy(RPN)or traditional laparoscopic partial nephrectomy(LPN).Materials and Methods:A total of 338 patients underwent partial nephrectomy in Sichuan Province People’s Hospital from September 2014 to August 2019 were enrolled in the retrospective analysis,among which 138 cases underwent Da Vinci robotic assisted laparoscopic partial nephrectomy(RPN)while 200 cases underwent traditional laparoscopic partial nephrectomy(LPN)(transperitoneal laparoscopic partial nephrectomy(RLPN)180 cases,retroperitoneal laparoscopic partial nephrectomy(TLPN)20 cases).Three observers scored preoperative imaging data(CT/MRI)of patients in this research by R.E.N.A.L nephrectomy scoring system,and divided the scores into lower complexity group(148 cases),moderate complexity group(146 cases),high complexity group(44 cases),to compare the relationship of the clinical data of different groups.Result:1.There was a significant difference in R.E.N.A.L score between RPN group and LPN group(χ~2=27.893,P=0.000).The proportion of moderate and highly complex tumors in the RPN group was 72.46%(100/138),significantly higher than that in the LPN group 45.00%(90/200).In general,RPN has more advantages in the control of complications than the LPN(10.14%vs22.50%),but the operation time,warm ischemia time,length of postoperative hospital stay in RPN group is longer than LPN group,and the hospitalization cost is higher.2.Stratified by R.E.N.A.L score,both in RPN and LPN groups,there were significant differences between different R.E.N.A.L score categories in the operation time,warm ischemia time,intraoperative blood loss.In RPN group,the more complicated the tumor,the higher the hospitalization cost,while in LPN group,there was no such trend.In LPN group,the more complicated the of the tumor,the higher the risk of complications,but there was no such trend in RPN group.Lower complexity group were more likely to undergo LPN(74.32%),high complexity group were more likely to undergo RPN(66.64%),and there were no statistically significant difference in moderate complexity group.3.In lower complexity group,RPN is more likely to be used in patients with high BMI,with no statistically significant difference in complication compared with LPN,and the operation time,length of postoperative hospital stay are longer and the hospitalization cost are higher in RPN group.In moderate and high complexity groups,RPN has an advantage over LPN in the control of complications(13.00%vs35.56%),but it also has the problems of longer operation time and higher hospitalization cost.At the same R.E.N.A.L score,there was no statistically significant difference in warm ischemia time between RPN and LPN group.Conclusion:1.R.E.N.A.L scoring system can reflect the anatomical characteristics of renal tumor,and can predict the operation time,warm ischemia time,and intraoperative bleeding of partial nephrectomy.It also can predict the hospitalization cost of RPN and the incidence of complications of LPN.R.E.N.A.L scoring system has a guiding significance in the choice of surgical approach for partial nephrectomy.2.LPN is more suitable for low-grade complicated renal tumors,which can reduce the operation time,postoperative hospitalization time and hospitalization cost.RPN is more suitable for moderate and highly complex tumors,which can reduce the difficulty of surgery and reduce the occurrence of complications,but it also has the disadvantages of long operation time and high hospitalization cost.