The Study Of Application Of The Modified RoSCo Scoring System In The Retroperitoneal Laparoscopic Partial Nephrectomy

Objective:If partial nephrectomy is suitable for T1N0M0 stage renal tumors,especially T1a N0M0 stage renal tumors,partial nephrectomy is recommended in the literature guidelines.With the effective development of precision medicine,it is suggested that we should not simply choose the operation plan according to the recommendations in the literature guidelines,but should make individual and accurate operation plan according to the actual situation of patients.However,the existing scoring systems have some limitations,so this paper mainly discusses the application of the modified RoSCo scoring system in retroperitoneal laparoscopic partial nephrectomy.Methods:1.Clinical data of patients who underwent retroperitoneal laparoscopic partial nephrectomy in our hospital from 2014 to 2019 were collected,including basic information of patients,preoperative ACCI index,RENAL score,BMI index,MAP,number of renal artery branches on the affected side,tumor size,operation time,intraoperative bleeding,warm ischemia time,postoperative complication score(Clavien score)and so on.2.The modified RoSCo scoring method:renal score 4-9(1 point),≥10(5 points);a CCI0-2(1 point),3-5(2 points),6-8(3 points),≥9(4 points);MAP 0-1(1 point),2(2points),3(3 points),4(4 points),5(5 points);number of renal artery branches 1(1 point),2(3 points),3(5 points).The sum of the above four scores is the final modified RoSCo score.In addition,the postoperative complication score of Clavien was given according to the postoperative complications.3.Statistical methods:the counting data were described by quantity and percentage,and the differences between groups were analyzed by Pearson chi-square test or Fisher’s accurate test.The measurement data were expressed by mean±standard deviation.The two independent samples were compared by independent sample t test.The differences between groups were compared by univariate ANOVA analysis or nonparametric Kruskal-Wallis H test.The correlation between modified RoSCo score system and perioperative index was evaluated by multiple linear regression and the correlation between modified RoSCo score system and complications was analyzed by Logistic regression.The correlation between groups was analyzed by Spearman rank correlation analysis.For the RoSCo scoring system and the modified RoSCo scoring system,the sensitivity,specificity and Yoden index were compared to evaluate the difficulty of the actual operation.All data were analyzed by SPSS25.0 software.P<0.05 indicates that the difference is statistically significant(double tail).Results:1.Among all the subjects included in the study,the average age of all subjects in the complication group was 58.93 years old,and the average age of all subjects without complication group was 56.81 years old.There was no significant difference in age between the complication group and the non-complication group(P=0.37).There were 77 males(67.0%)and 38 females(33.0%).There was no significant difference in gender composition between groups with and without complications(P=0.433).2.Among the subjects included in the study,there were 57 patients(49.6%)with BMI≤25 kg/m~2,and 58 patients(50.4%)with BMI>25 kg/m~2,no significant difference in the composition between the complication group and the non-complication group(P=0.067).CCI,Renal score,a CCI,MAP,the number of renal artery branches and the diameter of renal tumor were significantly different between the complication group and the non-complication group(P<0.05),and were related to Clavien grade(P<0.05).3.There were significant differences in average postoperative hospital stay,average intraoperative blood loss,average warm ischemia time,average time of drainage tube extraction and average operation time among the groups with 1,2 and≥3 renal artery branches(P<0.05).4.There was no significant difference in sex and age among the low,middle and high RoSCo score and modified RoSCo score,but there were significant differences in hospital stay,operation time,intraoperative blood loss,warm ischemia time and postoperative drainage time(P<0.05).5.RoSCo score and modified RoSCo score in low,medium and high scores were significantly different between patients with complications and those without complications,and RoSCo score and modified RoSCo score were related to Clavien grade of complications(P<0.05).6.The sensitivity,specificity and Youden index of the RoSCo scoring system were compared with the improved RoSCo scoring system,and the improved RoSCo scoring system was generally higher than the RoSCo scoring system7.Logistic regression analysis showed that in renal score system,RoSCo score system and modified RoSCo score system,only the modified RoSCo score system was related to the total incidence of complications(P<0.001).Multiple linear regression analysis showed that the modified RoSCo score system was correlated with operation and postoperative hospital stay(P<0.001).Conclusion:1.CCI,a CCI,number of renal artery branches,MAP score,renal score,renal tumor diameter,RoSCo score system and modified RoSCo score system were all related to operation time,warm ischemia time,intraoperative bleeding,postoperative hospital stay and drainage tube extraction time during and after retroperitoneal laparoscopic partial nephrectomy,and were related to postoperative complications.2.Compared with RoSCo scoring system and Renal scoring system,the modified RoSCo scoring system can better predict the related indexes and complications during and after operation.