| Objective: To assess the role of the arterial based complexity(ABC)scoring system in predicting clinically relevant outcomes of minimally invasive partial nephrectomy(MIPN).Design and participants: We retrospectively analyzed the information on patients with renal cancer who underwent minimally invasive partial nephrectomy in our hospital from June 2016 to January 2018.Of the 161 patients enrolled,122(75.8%)were male and 39(24.2%)were female,130(80.7%)were treated with laparoscopic partial nephrectomy(LPN),and 31(19.3%)were treated with robot-assisted laparoscopic partial nephrectomy(RAPN).The information collected included the patient’s general condition,imaging examination images,surgical related parameters,postoperative pathological data,perioperative complications,and postoperative renal function follow-up data.ABC scores on abdominal contrast-enhanced CT of 161 patients undergoing minimally invasive partial nephrectomy were independently assessed by 3 physicians in our hospital,including 1 chief radiologist,1 attending urologist and 1 urological resident。Assessment method:The ABC scoring system classifies renal parenchymal tumors according to the grade at which the vessels need to be dissociated or cut during partial nephrectomy.Based on the enhanced CT images of the patients,they were divided into grades 1,2,3S and 3H.Grade 1,2,and 3S require transection of interlobular artery and arcuate artery,interlobar artery,and renal segmental artery,respectively,in the resection of renal tumors.Tumors that are close to or involved in renal hilar vessels were grade 3H.Statistical analysis: The consistency of ABC scores of different physicians was assessed by calculating the Kappa value and the number and percentage of cases with exactly the same score for every 2 physicians.Chi-square test or Fisher’s exact test were used analyzing the relationship between the ABC scoring system and the patients’ clinicopathological features.Meanwhile,the rank sum test was used analyzing the relationship between the ABC scoring system and surgically relevant variables,and one-way ANOVA for the relationship between the ABC scoring system and renal function in patients.Results: Taking the results of the chief physician of the radiology department as the reference standard,among the 161 patients who underwent minimally invasive partial nephrectomy,the number of patients with grade 1,2,3S,and 3H was 33(20.5%)and 97(60.2).%),19(11.8%),12(7.5%),respectively.The results of physician scores were statistically significant(P<0.001),the average exact match percentage is 70.2%,and average kappa=0.523 across all physician pairs.The Kappa value of the chief physician and the attending physician was 0.545,the Kappa value of the chief physician and the resident was 0.516,and the Kappa value of the attending physician and the resident was 0.508.The difference was statistically significant(P<0.01).The attending physician and the chief physician had the same scores in 116 cases(72%).The attending physicians and the resident physicians had the same scores in 110cases(68.3%)and the resident doctors and the chief physicians had the same scores in 113 cases(70.2%),the average exact match percentage is 70.2%.ABC score was significantly associated with operative time(P<0.001),warm ischemia time(P<0.001),estimated blood loss(P<0.001),and was independent of postoperative hospital stay(P=0.321).Tumor size were significantly correlated with ABC scoring system(P<0.001).There were no significant differences in age,gender,BMI,ASA,tumor location,postoperative pathological type,and complication rate among the four categories of ABC scoring system(P>0.05).There was no significant correlation between the ABC scoring system and preoperative estimated glomerular filtration rate(eGFR)and estimated glomerular filtration rate at 3 and 6 months postoperatively(all P>0.05).Conclusion: The ABC scoring system is the first new scoring system centered on the depth of renal tumor invasion and the vascular anatomy of the renal artery.The ABC scoring system was significantly associated with intraoperative warm ischemia time(WIT),operative time,and estimated blood loss(EBL)in patients with minimally invasive partial nephrectomy,and was not significantly associated with postoperative hospital stay.The ABC scoring system has certain predictive significance for the complexity of minimally invasive partial nephrectomy..This scoring system is not a predictor of postoperative complications and renal function. |
