| Objective: The R.E.N.A.L score in stage T1 renal tumor were retrospectively analyzed for its correlation with the surgical approach, the preoperative outcomes such as surgical time, renal warm ischemia time,the percentage change of the serum creatinine level as well as estimated blood loss and R.E.N.A.L score were analyzed.Method: Patients with T1 renal tumor were included in this retrospective study, which was conducted in the Second Affiliated Hospital of Soochow University from January2011-July 2015. Basic data, such as age and gender and other tumor characterization, were collected. Morphological characteristics of the tumor were evaluated by the preoperative CT images according to the R.E.N.A.L. score and according to the score number, the degree of complexity were classified into three groups: low(4-6 score), medium(7-9 score)and high(10-12 score). Postoperative complications were evaluated according to the Clavien grading system. Surgical time, renal warm ischemia time, blood loss, preoperative and postoperative creatinine level were also analyzed in the three groups. The relationship between the R.E.N.A.L score and the surgical approach, nephron-sparing surgery method were analyzed. And evaluate the correlation between the R.E.N.A.L. score, surgical time,warm ischemia time, estimated blood loss in different nephron-sparing surgery group.Results: A total of 131 cases with T1 renal tumor were included for further analysis.31, 62 and 38 patients were classified into the low, medium and high complexity group respectively. In the low complexity group, 4 patients were underwent open radical nephrectomy(ORN) and 6 patients underwent laparoscopic radical nephrectomy(LRN), 21 patients were underwent laparoscopic nephron-sparing partial nephrectomy(LNSS),include 5 patients underwent pure laparoscopic nephron-sparing partial nephrectomy(NSS)and 16 patients underwent laparoscopic NSS with segmental renal artery clamping.In the moderate complexity group, 20 patients were underwent ORN and 19 patients underwent LRN, 23 patients underwent laparoscopic NSS, include 2 patients underwent laparoscopic NSS with segmental renal artery clamping.In the high complexity group, 20 patients underwent OPN and 7 patients underwent LPN,11 patients underwent laparoscopic NSS, include 10 patients underwent pure laparoscopic NSS and and 1 patients underwent laparoscopic NSS with segmental renal artery clamping.No statistical difference was found related to age and gender between the three groups.R.E.N.A.L. score were significantly associated with the surgical approach(P=0.003).Among the NSS patients, the mean warm ischemia time was 18.5, 22.0 and 35.0 minutes respectively in the low, medium and high complexity groups, which have statistical differences between each two groups. The R.E.N.A.L. score were significantly associated with the surgical time, warm ischemia time, estimated blood loss and there was no statistical difference when concerning with the changed creatinine level tested in the first day after the operation.Conclusion: R.E.N.A.L. score provides a useful standard for evaluating the complexity of renal tumor. It has good clinical maneuver ability and can be used as a guide for choosing surgical approach for patients with T1 stage renal cancer. |
