PADUA and RENAL nephrometry scores correlates with perioperative outcomes after robot-assisted partial nephrectomy: analysis of the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database.

Abstract

OBJECTIVES: To evaluate and compare the correlations between PADUA and RENAL scores and perioperative outcomes and postoperative complications in a multicenter, international series of patients undergoing Robot-assisted partial nephrectomy (RAPN) for masses suspicious of RCC. PATIENTS AND METHODS: We retrospectively evaluated the clinical records of patients who underwent RAPN between 2010 and 2013 for clinical N0M0 renal tumours in four international Centers that completed all the data required for the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. All patients underwent pre-operative computed tomography or magnetic resonance imaging to define the clinical stage and anatomic characteristics of the tumors. PADUA and RENAL scores were retrospectively assessed in each Center. Univariate and multivariate analyses were performed to evaluate the correlations between age, gender, Charlson comorbidity index, clinical tumor size, PADUA and RENAL complexity group categories and warm ischemia time >20 minutes, urinary calyceal system closure and grade of postoperative complications. RESULTS: Overall, 277 patients have been evaluated. The median tumor size was 33.0 millimeters (22.0-43.0). The median PADUA and RENAL score were 8 and 7 respectively; 112 (40.4%), 86 (31.0%) and 79 (28.5%) patients were classified in the low, intermediate or high-complexity group according to PADUA score, while 118 (42.5%), 139 (50.1%) and 20 (7.2%) were classified in the low, intermediate or high-complexity group according to RENAL score, respectively. Both nephrometric tools significantly correlated with perioperative outcomes at univariate and multivariate analyses. CONCLUSION: A precise stratification of patients before partial nephrectomy is recommended, allowing to balance the potential threats and benefits of nephron-sparing surgery. In our analysis, both PADUA and RENAL were significantly associated with prolonged WIT and high-grade postoperative complications after RAPN.