| Background:The nephron-sparing surgery(NSS)has become the primary method for the treatment of renal tumors in T1a,and With the development of surgical techniques and instruments,it has been used in more complex tumors(eg.tumors larger than 4cm or complex tumor in the renal portal).However,there are some problems with the nephron-sparing surgery to be solved.Compared to the traditional radical nephrectomy(RN),NSS required higher surgical technological level.It may lead to not only longer operation time or renal warm ischemia time(WIT),but also higher rate of surgical bleeding or postoperative complication When operator encounter a complex tumor.The anatomical feature of kidney cancer is an important factor in the formulation of surgical treatment.How to evaluate patients and develop individualized solutions before surgery?The answer should not be diameter,position,and experience.The latest renal cancer guidelines(2017)of American urological association(AUA)makes clear that the kidney should be kept as much as possible which is critical for kidney function.The renal tumor complexity scoring system provides new ideas for solving such problems.The preoperative diagnosis of tumor complexity can effectively reduce the WIT and normal kidney loss,retention of the renal parenchyma as much as possible in surgery,and provide better condition of postoperation for the recovery of renal function.In addition,more accurate diagnosis of renal function helps clinicians intervene at its early stage,to protect the function of kidney after nephron-sparing surgery.objective:To study the clinical effect by using DAP renal tumor complexity scoring system in nephron-sparing surgery,and clarify its significance.Methods:A retrospective analysis was conducted of clinical data of 55 patients with renal neoplasms undergoing nephron sparing surgery,who were admitted to Nanjing First Hospital Affiliated to Nanjing Medical University from June 2012 to october 2016.The information of gender,age,surgical duration,warm ischemia time,blood loss volume and postoperative complications were collected.The percent functional volume preservation was calculated using cylinder volume ratio.DAP scores were performed based on pre-operative CT or MRI data by 2 urologist independently(1 resident doctor Marked as U1,1 associate Chief Physician marked as U2).Analyzing the relationship between DAP scores and gender,age,surgical duration,warm ischemia time,blood loss volume,postoperative complications and percent functional volume preservation.Data were analyzed by rank sum test.Results:The DAP score was significantly associated with the surgical duration(P<0.001),warm ischemia time(P<0.001),blood loss volume(P<0.001),serum creatinine level of 1 day after operation(P=0.003),postoperative complications and percent functional volume preservation(P<0.001),while there was no significant association between the scoring syste and the gender,age,postoperative complications,Preoperative blood creatinine and serum urea nitrogen level,serum urea nitrogen level of 1 day after operation.To test the consistency of the scores of two urologists using DAP systems independently using the consistency check(kappa),and the kappa value is 0.735,which indicates that DAP scores are highly consistent.Conclusion:1.The DAP scoring system was improved on the basis of the first-generation renal tumor scoring system with the characteristics of simple,objective,stable and easy to use.2.This scoring system was significantly associated with the surgical duration,warm ischemia time,blood loss volume,serum creatinine level of 1 day after operation,postoperative complications and especially PFVP,and predict the change of postoperative renal function effectively.3.The scoring system is consistent among different independent observers,and it is a reliability and repeatability tool. |
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