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Tumor diameter accurately predicts perioperative outcomes in T1 renal cancer treated with robot-assisted partial nephrectomy

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Abstract

Purpose

To compare diameter as a continuous variable with categorical R.E.N.A.L. nephrometry score (RNS) in predicting surgical outcomes of robotic partial nephrectomy (RPN).

Methods

We retrospectively reviewed consecutive patients receiving RPN at our institution between July 2007 and June 2014 (n = 286). Three separate multivariate analyses were performed to assess the relationship between RNS components (R = radius, E = endophyticity, N = nearness to collecting system, L = location relative to polar lines), total RNS, and diameter as a continuous variable with operating time, warm ischemia time (WIT), and estimated blood loss (EBL). Each linear regression model’s quality of fit to the data was assessed with coefficients of determination (R 2).

Results

Continuous tumor diameter and total RNS were each significantly correlated to operative time, EBL, and WIT (p < 0.001). Categorical R related to operative time (R = 2 vs. R = 1, p = 0.001; R = 3 vs. R = 1, p = 0.001) and WIT (R = 2 vs. R = 1, p = 0.003; R = 3 vs. R = 1, p = 0.016), but not to EBL. For each of these outcomes, diameter outperformed both R and total RNS, as assessed by R 2. Age, body mass index, Charlson Comorbidity Index, and anterior versus posterior location did not correlate with surgical outcomes.

Conclusions

In this series of RPN from a high-volume center, surgical outcomes more closely related to tumor diameter than RNS. While RNS provides surgeons a standardized tool for preoperative planning of renal masses, tumor size may be employed as a more familiar measurement when counseling patients on potential outcomes.

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Authors’ contribution

Aaron M. Potretzke and Brent A. Knight were involved in project development, data collection and management, and manuscript writing and editing. Theodora A. Potretzke and Alyssa M. Park took part in data collection and management, and manuscript writing and editing. Joel Vetter participated in data collection and management, data analysis, and manuscript writing and editing. Grecori Anderson was involved in data collection and management. Sam B. Bhayani and Robert S. Figenshau participated in project development, and manuscript writing and editing.

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Authors and Affiliations

  1. Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO, 63110, USA

    Aaron M. Potretzke, B. Alexander Knight, Joel Vetter, Alyssa M. Park, Grecori Anderson, Sam B. Bhayani & R. Sherburne Figenshau

  2. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA

    Theodora A. Potretzke

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  1. Aaron M. Potretzke
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Correspondence to Aaron M. Potretzke.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Potretzke, A.M., Potretzke, T.A., Knight, B.A. et al. Tumor diameter accurately predicts perioperative outcomes in T1 renal cancer treated with robot-assisted partial nephrectomy. World J Urol 34, 1643–1650 (2016). https://doi.org/10.1007/s00345-016-1809-3

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