Analysis Of Related Factors By R.E.N.A.L. Nephrometry Score After Retroperitoneal Laparoscopy Partial Nephrectomy

Objective To assess the use of the R.E.N.A.L(radius,exophytic,nearness to collecting system,anterior/posterior and location)nephrometry scoring system scoring system for renal tumors underwent retroperitoneal laparoscopic partial nephrectomy during operation period,to predict surgical outcomes and to estimate the percent of functional volume preservation..Methods A retrospective analysis was conducted of clinical data of 173 patients with renal neoplasms undergoing laparoscopic partial nephrectomy,who were admitted to The Second Hospital Affiliated to Tianjin Medical University and First Hospital of Hebei Province,Shijiazhuang city from January2009 to December 2013.The operation approaches,perioperative variables and perioperative complications as well as R.E.N.A.L.scores were compared.Univariate and multivariate analysis the relationship between preoperative variables and complications.Analysis the relationship of the operation time,intraoperative estimated blood loss(EBL),warm ischemia time(WIT)with the R.E.N.A.L.scores.2 cases were excluded because of bleeding after surgery underwent selective renal artery embolization and 2 cases with renal resection.CT or MRI,renal artery imaging of the remaining 169 patients analysis and measurement,The cylinder volume ratio calculation method was appled to estimate the percent of functional volume preservation.To analysis GFR of42 patients by preoperative and postoperative SPECT.Finally,To evaluate quantitatively the effect of increasing experience,patients were stratified in chronological order by quartiles into groups of 15 patients.Results R.E.N.A.L nephrometry score: low 103(59.5%),Moderate64(37%),high 6(3.5%).the WIT(16 vs 23 vs 32 minutes;P < 0.001),EBL(156 vs305 vs 310 ml;P =0.03)and the LOS(17 vs 20 vs 22 days;P=0.014)had significant difference in three groups.The OT(P =0.83),preoperative Ccr(P = 0.85)or postoperative Ccr(P = 0.42)had no significant difference.Most of the patients had no complications.35 patients(20.2%)occurred in 41 cases of complications.The the rates of postoperative complications in the high tumor score groups are higher than the low score groups.Compared no complications of patients withcomplications,Middle and high tumor score groups complications occurrence rate is high(77% vs 31%,P =0.01).The OT was longer(176vs160min,P =0.01),the EBL was higher(307 vs 251 ml,P<0.001),collection system open more common(42vs29%,P =0.01).The LOS was significantly prolonged in patients(24.5vs19.0 days,P<0.001).The average operation side PFVP is 80%+ 9%.RENAL score correlated with PFVP(P<0.001).The score for each increase of 1 points and the renal function of related units to reduce 5%.GFR was 45.83 ml/min(29-61.2)in the preoperative lateral renal,36.71 ml/min(21-43)after one week(decreased 19.9%);40.51 ml/min(33-43)after 6 months,although recovered somewhat but still decreased remarkably and the difference was significant(P<0.05).The R.E.N.A.L score was significantly associated with the operative lateral renal function(P = 0.019).With the operation experience of operation increases,the ratio of high complexity cases increas 47%.There is little difference in incidence rate of postoperative complications.Conclusion The higher R.E.N.A.L.scores were significantly associated with increased EBL,prolonging LOS and WIT in the laparoscopic partial nephrectomy.The R.E.N.A.L score was significantly associated with the operation side kidney function decline and perioperation complications.The R.E.N.A.L nephrometry scoring system is repeatable in different operators and has good stability.Identification of these parameters can be used to evaluate surgical complexity and technical difficulty,and to effectively communicate with patients before surgery and to make decisions on surgical options.