| Background:Renal cell carcinoma accounts for 2-3%of the world's tumors,a higher incidence in Western countries.Over the past 20 years,the incidence of renal cell carcinoma worldwide has increased by 2%.According to statistics,in 2012 the EU countries have nearly 84400 cases of new renal cancer cases,and 34700 patients died of renal cancer-related diseases.Different renal cell carcinoma has its special histopathological and genetic characteristics.Men are more prone to renal cell carcinoma,the incidence of male to female ratio is 1.5:1,probably in the 60-70 year-old renal cell incidence peak.The high risk factor of renal cell carcinoma included smoking,obesity,hypertension,drugs,radiation,family history.The incidence of RCC patient's descendant is higher,and some other factors are more or less influencing the pathogenesis of RCC,such as special bad eating habits and exposure to carcinogens.At present,for the local renal tumors,no matter what surgical approach,we tend to use partial nephrectomy resection to replace radical nephrectomy.Many studies have compared the small cell renal cell carcinoma(tumor diameter less than 4cm)partial nephrectomy and renal cell carcinoma radical nephrectomy of the differences between this two ways.A recent randomized controlled trial showed that for those renal tumors less than 5cm in diameter of renal cell carcinoma,renal cell carcinoma partial resection and radical resection of renal cell carcinoma survival rate was not significantly different.For renal cell carcinoma diameter 4-7cm in patients with renal cell carcinoma,partial nephrectomy and renal cell carcinoma radical resection does not affect the 5-year survival rate.There was no significant difference in survival rate and recurrence rate between the patients undergoing retroperitoneal laparoscopic partial nephrectomy and retroperitoneal laparoscopic radical nephrectomy for renal tumors larger than 4 cm in diameter,and the time of hospitalization,Intraoperative blood loss,blood transfusion rates were not significantly different,but the differences in postoperative complications are not known.For renal cell carcinoma diameter 4-7cm,having open partial nephrectomy or open radical nephrectomy,the creatinine levels in patients with open partial nephrectomy will be lower.In another study,comparing retroperitoneal laparoscopic partial nephrectomy and retroperitoneal laparoscopic radical nephrectomy,the results showed that retroperitoneal laparoscopic partial nephrectomy in patients with glomerular filtration rate changes less.Partial resection of renal tumors is currently considered the "gold standard" for the treatment of renal tumors with a diameter of<4 cm.However,many research reported the partial resection of renal tumors in 4 to 7 cm renal tumors did not significantly increase surgical complications.So simply in accordance with the diameter of the renal tumor to determine the surgical approach is not reasonable.In 2009 Kutikov and Uzzo proposed RENAL renal tumor scoring system,the same year Ficarr put forward the PADUA renal tumor scoring system,the above two scoring systems are based on the anatomical characteristics of renal tumors,through the renal tumor score can assess the complexity of surgery to predict surgical risk.Although the anatomical characteristics of renal tumors to a large extent affect the difficulty of surgery,but we can not ignore the preoperative disease and renal peritoneal fat on the impact of surgery.In 2014,Marco Roscigno et al developed a new and more accurate scoring model combining the RENAL renal tumor scoring system,the Charlson Comorbidity Index(CCI)and the Body Mass Index(BMI).The aim of this study was to explore the application of RoSCo scoring model in retroperitoneal laparoscopic partial nephrectomy.Materials and Methods:1?The clinical data of 127 patients undergoing retroperitoneal laparoscopic partial nephrectomy were retrospectively analyzed,including the basic information of patients,preoperative CCI index,RENAL score,BMI index,tumor size,Operation time,intraoperative bleeding,warm ischemia time,postoperative complications score(Clavein score)and other related data.RoSCo low score group(3-4 points),RoSCo middle score group(5-6 points),and RoSCo high score group(7-8)were scored according to the RENAL tumor scoring,CCI index and BMI index.2?RoSCo scoring method:RENAL 4-9(1 point),RENAL?10(5 points);CCI 0(1 point),1-2(2 points),>2(3 points);BMI?25(1 point),>25(2 points);The sum of the above three scores is the final RoSCo score.The RoSCo score was evaluated by a urologist before the operative data were obtained.The urologist was not aware of the surgery-related condition and the postoperative condition.The general clinical data,intraoperative related clinical data,postoperative related complications and the postoperative complication score of Clavein were collected by another urologist.3?Statistical methods:Statistical analysis using SPSS 19.0 statistical software,measurement data with x±s,the sample rate and composition ratio of comparison with X2 test,the comparison of two sample use t-test,using Kappa values to detect the consistency of different physicians in evaluating RoSCo scoring system,P<0.05 was statistically significant.Result:1?The mean age of the 127 patients in this study was 57.5 years,the mean age of patients without complications was 56.0 years,and the mean age of patients with postoperative complications was 55.9 years,with the 66 man(52.0%),61 females(48.0%).There were no significant differences in age and sex between the complication group and the no-complication group,and there were no significant differences between the Clavein 0,Clavein 1-2,Clavein 3-5(p>0.05).2?Among the 127 patients studied,there were 81 patients(63.8%)with BMI<25,46 patients(36.2%)with BMI>25;88 patients(69.3%)with CCI 0,25 patients(19.7%)CCI 1-2,14 patients(11.0%)with CCI>2;76 patients(59.8%)with RENAL renal tumor score of 4-6,29 patients(22.8%)with RENAL renal tumor score 7-9,22 patients(17.4%)with RENAL renal tumer score of 10-12;91 patients(71.6%)of RoSCo score 3-4,17 patients(13.4%)of RoSCo score 5-6,19 patients(15.0%)with RoSCo score 7-8,27 patients(21.3%)with renal tumor diameter<4cm,97 patients(76.4%)with renal tumor diameter 4-7cm,and 3 patients(2.3%)renal tumor diameter>7cm,BMI index,CCI index,RENAL renal tumor score,RoSCo score,tumor size is different in the no-complication group and complication group,and these index is related with Clavein grade.3?To compare the relative accuracy of RoSCo score and RENAL score in the prediction of postoperative complications,we studied the distribution of patients with complications in RoSCo score and RENAL score in low,middle and high groups.RoSCo 3-4 point,5-6 points,7-8 point group with no complications in patients accounted for 91.2%,47.1%,36.8%,while RoSCo score 3-4 points,5-6 points,7-8 group of patients with complications accounted for 8.8%,52.9%,63.2%.The RENAL score of 4-6,7-9 and 10-12 with no complications in patients accounted for 86.8%,65.5%and 59.1%.Respectively,the RENAL score of 4-6,7-9 and 10-12 with complications in patients accounted for 13.2%,34.5%,40.9%.So,this means that,contrast to the RENAL scoring system,the RoSCo scoring system is more closely related to the postoperative complications of retroperitoneal laparoscopic partial nephrectomy.4?There was no statistically significant difference in sex distribution between the low,middle and high RoSCo groups(P>0.05).The mean age in the low,middle,and high RoSCo groups was 56.8,59.8,58.6 years,respectively,with no statistically significant difference.In the low,middle and high groups of RoSCo,the mean values of intraoperative bleeding were 110,143,190ml,the mean warm ischemia time was 27.6,29.5,31.5min,the average hospitalization time was 9.2,10.5,10.9 days,the mean operative time was 128,135,163min.The bleeding value,the duration of warm ischemia and the operation time were statistically different between RoSCo low,middle and high groups.4?The Kappa consistency test was used to analyze the RoSCo scoring system,The consistency of the RoSCo score and each component score were 0.97,0.97,0.96 and 0.94,respectively,and the Kappa values were 0.98,0.95,0.96,0.87,respectively.Conclusion:1?BMI index,CCI index,RENAL scoring system are associated with postoperative complications of retroperitoneal laparoscopic partial nephrectomy.RoSCo scoring system is also associated with postoperative complications of retroperitoneal laparoscopic partial nephrectomy,can be better assessed the Postoperative complications.2?Compared with the RENAL scoring system,the RoSCo scoring system is more closely related to the postoperative complications of retroperitoneal laparoscopic partial nephrectomy,which can predict the postoperative complications of partial nephrectomy.3?There was no significant correlation between gender,age and RoSCo scoring system.The bleeding,warm ischemia time,hospital stay and operation time were correlated with the RoSCo scoring system.The higher the RoSCo score,the greater the intraoperative blood loss,the longer warm ischemia time,the longer patient's hospital stay,the longer the patient's operation time.4?The consistency of different urologists using RoSCo scoring system is good,highly reproducible,can be used for different physician. |
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