Renal Cancer pp 185-195 | Cite as

Objectifying Complexity of Kidney Cancers: Relationship of Tumor Anatomy and Outcomes

  • Serge Ginzburg
  • Alexander Kutikov
  • Robert G. Uzzo
  • Stephen B. SchlossEmail author


A standardized classification system to communicate relevant attributes of renal tumors did not exist until recently. The emergence and subsequent validation of the RENAL nephrometry score and soon thereafter several other systems have allowed reproducible objectification, reporting, and comparison of salient anatomic features of renal tumors. As such, quantification of anatomic tumor attributes has afforded meaningful correlation of tumor anatomy to surgical, functional, and oncologic outcomes, allowing prognostication of not only perioperative outcomes but also tumor biology. As such, objective and standardized reporting of renal anatomy has now become integral to individualized treatment selection.


Renal tumor Renal mass Radical nephrectomy Warm ischemia time Renal sinus 


  1. 1.
    Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin. 2012;62(1):10–29.CrossRefGoogle Scholar
  2. 2.
    Simard EP, Ward EM, Siegel R, Jemal A. Cancers with increasing incidence trends in the United States: 1999 through 2008. CA Cancer J Clin. 2012;62:118–28.CrossRefPubMedGoogle Scholar
  3. 3.
    Parsons JK, Schoenberg MS, Carter HB. Incidental renal tumors: casting doubt on the efficacy of early intervention. Urology. 2001;57(6):1013–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Cooperberg MR, Mallin K, Kane CJ, Carroll PR. Treatment trends for stage I renal cell carcinoma. J Urol. 2011;186(2):394–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Robson CJ, Churchill BM, Anderson W. The results of radical nephrectomy for renal cell carcinoma. J Urol. 1969;101(3):297–301.CrossRefGoogle Scholar
  6. 6.
    Volpe A, Cadeddu JA, Cestari A, et al. Contemporary management of small renal masses. Eur Urol. 2011;60(3):501–15.CrossRefPubMedGoogle Scholar
  7. 7.
    Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182(4):1271–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Ljungberg B, Cowan NC, Hanbury DC, et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol. 2010;58(3):398–406.CrossRefPubMedGoogle Scholar
  9. 9.
    Patel SG, Penson DF, Pabla B, et al. National trends in the use of partial nephrectomy: a rising tide that has not lifted all boats. J Urol. 2012;187(3):816–21.CrossRefPubMedGoogle Scholar
  10. 10.
    Kunkle DA, Egleston BL, Uzzo RG. Excise, ablate or observe: the small renal mass dilemma-a meta-analysis and review. J Urol. 2008;179(4):1227–33; discussion 1233–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Van Poppel H, Da Pozzo L, Albrecht W, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011;59(4):543–52.CrossRefPubMedGoogle Scholar
  12. 12.
    Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr. Rising incidence of renal cell cancer in the United States. JAMA. 1999;281(17):1628–31.CrossRefPubMedGoogle Scholar
  13. 13.
    Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006;98(18):1331–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Snyder ME, Bach A, Kattan MW, Raj GV, Reuter VE, Russo P. Incidence of benign lesions for clinically localized renal masses smaller than 7 cm in radiological diameter: influence of sex. J Urol. 2006;176(6 Pt 1):2391–5; discussion 2395–6.CrossRefPubMedGoogle Scholar
  15. 15.
    McKiernan J, Yossepowitch O, Kattan MW, et al. Partial nephrectomy for renal cortical tumors: pathologic findings and impact on outcome. Urology. 2002;60(6):1003–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Smaldone MC, Kutikov A, Egleston BL, et al. Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis. Cancer. 2012;118(4):997–1006.CrossRefPubMedGoogle Scholar
  17. 17.
    Smaldone MC, Uzzo RG. Active surveillance: a potential strategy for select patients with small renal masses. Future Oncol. 2011;7(10):1133–47.CrossRefPubMedGoogle Scholar
  18. 18.
    Canter D, Kutikov A, Manley B, et al. Utility of the R.E.N.A.L. nephrometry scoring system in objectifying treatment decision-making of the enhancing renal mass. Urology. 2011;78(5):1089–94.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Weight CJ, Crispen PL, Breau RH, et al. Practice-setting and surgeon characteristics heavily influence the decision to perform partial nephrectomy among American urologic association surgeons. BJU Int. 2013;111(5):731–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Volpe A, Terrone C. Anatomic classification systems of renal tumors: new, useful tools in renal surgical oncology. Eur Urol. 2011;60(4):731–3.CrossRefPubMedGoogle Scholar
  21. 21.
    Buechter KJ, Zeppa R, Gomez G. The use of segmental anatomy for an operative classification of liver injuries. Ann Surg. 1990;211(6):669–73; discussion 673–5.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Couinaud C. Liver anatomy: portal (and suprahepatic) or biliary segmentation. Dig Surg. 1999;16(6):459–67.CrossRefPubMedGoogle Scholar
  23. 23.
    Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182(3):844–53.CrossRefGoogle Scholar
  24. 24.
    Flocks RH, Kadesky MC. Malignant neoplasms of the kidney; an analysis of 353 patients followed five years or more. J Urol. 1958;79(2):196–201.CrossRefPubMedGoogle Scholar
  25. 25.
    Nguyen CT, Campbell SC. Staging of renal cell carcinoma: past, present, and future. Clin Genitourin Cancer. 2006;5(3):190–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Guinan P, Sobin LH, Algaba F, et al. TNM staging of renal cell carcinoma: Workgroup No. 3. Union International Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer. 1997;80(5):992–3.CrossRefPubMedGoogle Scholar
  27. 27.
    Elmore JM, Kadesky KT, Koeneman KS, Sagalowsky AI. Reassessment of the 1997 TNM classification system for renal cell carcinoma. Cancer. 2003;98(11):2329–34.CrossRefPubMedGoogle Scholar
  28. 28.
    Patard JJ, Pantuck AJ, Crepel M, et al. Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication. Eur Urol. 2007;52(1):148–54.CrossRefPubMedGoogle Scholar
  29. 29.
    Crispen PL, Boorjian SA, Lohse CM, et al. Outcomes following partial nephrectomy by tumor size. J Urol. 2008;180(5):1912–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Campbell SC, Novick AC, Streem SB, Klein E, Licht M. Complications of nephron sparing surgery for renal tumors. J Urol. 1994;151(5):1177–80.CrossRefPubMedGoogle Scholar
  31. 31.
    Simmons MN, Fergany AF, Campbell SC. Effect of parenchymal volume preservation on kidney function after partial nephrectomy. J Urol. 2011;186(2):405–10.CrossRefPubMedGoogle Scholar
  32. 32.
    Lane BR, Russo P, Uzzo RG, et al. Comparison of cold and warm ischemia during partial nephrectomy in 660 solitary kidneys reveals predominant role of nonmodifiable factors in determining ultimate renal function. J Urol. 2011;185(2):421–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Wright JL, Porter JR. Laparoscopic partial nephrectomy: comparison of transperitoneal and retroperitoneal approaches. J Urol. 2005;174(3):841–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Ng CS, Gill IS, Ramani AP, et al. Transperitoneal versus retroperitoneal laparoscopic partial nephrectomy: patient selection and perioperative outcomes. J Urol. 2005;174(3):846–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Porpiglia F, Volpe A, Billia M, Renard J, Scarpa RM. Assessment of risk factors for complications of laparoscopic partial nephrectomy. Eur Urol. 2008;53(3):590–6.CrossRefPubMedGoogle Scholar
  36. 36.
    Reisiger K, Venkatesh R, Figenshau RS, Bae KT, Landman J. Complex laparoscopic partial nephrectomy for renal hilar tumors. Urology. 2005;65(5):888–91.CrossRefPubMedGoogle Scholar
  37. 37.
    Hruby G, Reisiger K, Venkatesh R, Yan Y, Landman J. Comparison of laparoscopic partial nephrectomy and laparoscopic cryoablation for renal hilar tumors. Urology. 2006;67(1):50–4.CrossRefPubMedGoogle Scholar
  38. 38.
    Raman JD, Smith B, Messer J, Rohner TJ, Harpster LE, Reese CT. Preoperative predictors of surgical approach for partial nephrectomy. Can J Urol. 2011;18(5):5896–902.PubMedGoogle Scholar
  39. 39.
    Lifshitz DA, Shikanov S, Jeldres C, et al. Laparoscopic partial nephrectomy: predictors of prolonged warm ischemia. J Urol. 2009;182(3):860–5.CrossRefPubMedGoogle Scholar
  40. 40.
    Kutikov ACP, Uzzo RG. The fox chase R.E.N.A.L. nephrometry score: a comprehensive standardized scoring system for assessing renal tumor size, location and depth. J Urol. 2009;181(suppl 1):354.CrossRefGoogle Scholar
  41. 41.
    Ficarra V, Novara G, Secco S, et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009;56(5):786–93.CrossRefPubMedGoogle Scholar
  42. 42.
  43. 43.
    Uzzo RG, Cherullo EE, Myles J, Novick AC. Renal cell carcinoma invading the urinary collecting system: implications for staging. J Urol. 2002;167(6):2392–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Cha EK, Ng CK, Jeun B, et al. Preoperative radiographic parameters predict long-term renal impairment following partial nephrectomy. World J Urol. 2013;31(4):817–22.CrossRefPubMedGoogle Scholar
  45. 45.
    Simmons MN, Ching CB, Samplaski MK, Park CH, Gill IS. Kidney tumor location measurement using the C index method. J Urol. 2010;183(5):1708–13.CrossRefPubMedGoogle Scholar
  46. 46.
    Hew MN, Baseskioglu B, Barwari K, et al. Critical appraisal of the PADUA classification and assessment of the R.E.N.A.L. nephrometry score in patients undergoing partial nephrectomy. J Urol. 2011;186(1):42–6.CrossRefPubMedGoogle Scholar
  47. 47.
    Kolla SB, Spiess PE, Sexton WJ. Interobserver reliability of the RENAL nephrometry scoring system. Urology. 2011;78(3):592–4.CrossRefPubMedGoogle Scholar
  48. 48.
    Montag S, Waingankar N, Sadek MA, Rais-Bahrami S, Kavoussi LR, Vira MA, et al. Reproducibility and fidelity of the R.E.N.A.L. nephrometry score. J Endourol. 2011;25(12):1925–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Okhunov Z, Rais-Bahrami S, George AK, et al. The comparison of three renal tumor scoring systems: C-Index, P.A.D.U.A., and R.E.N.A.L. nephrometry scores. J Endourol. 2011;25(12):1921–4.CrossRefPubMedGoogle Scholar
  50. 50.
    Weight CJ, Atwell TD, Fazzio RT, et al. A multidisciplinary evaluation of inter-reviewer agreement of the nephrometry score and the prediction of long-term outcomes. J Urol. 2011;186(4):1223–8.CrossRefPubMedGoogle Scholar
  51. 51.
    Waldert M, Waalkes S, Klatte T, et al. External validation of the preoperative anatomical classification for prediction of complications related to nephron-sparing surgery. World J Urol. 2010;28(4):531–5.CrossRefPubMedGoogle Scholar
  52. 52.
    Thompson RH, Lane BR, Lohse CM, et al. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol. 2010;58(3):340–5.CrossRefPubMedGoogle Scholar
  53. 53.
    Ficarra V, Bhayani S, Porter J, et al. Predictors of warm ischemia time and perioperative complications in a multicenter, international series of robot-assisted partial nephrectomy. Eur Urol. 2012;61(2):395–402.CrossRefPubMedGoogle Scholar
  54. 54.
    White MA, Haber GP, Autorino R, et al. Outcomes of robotic partial nephrectomy for renal masses with nephrometry score of ≥7. Urology. 2011;77(4):809–13.CrossRefPubMedGoogle Scholar
  55. 55.
    Samplaski MK, Hernandez A, Gill IS, Simmons MN. C-index is associated with functional outcomes after laparoscopic partial nephrectomy. J Urol. 2010;184(6):2259–63.CrossRefPubMedGoogle Scholar
  56. 56.
    Kutikov A, Smaldone MC, Egleston BL, et al. Anatomic features of enhancing renal masses predict malignant and high-grade pathology: a preoperative nomogram using the RENAL nephrometry score. Eur Urol. 2011;60(2):241–8.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Simhan J, Smaldone MC, Tsai KJ, et al. Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy. Eur Urol. 2011;60(4):724–30.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Novak R, Mulligan D, Abaza R. Robotic partial nephrectomy without renal ischemia. Urology. 2012;79(6):1296–301.CrossRefPubMedGoogle Scholar
  59. 59.
    Gill IS, Kavoussi LR, Lane BR, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007;178(1):41–6.CrossRefPubMedGoogle Scholar
  60. 60.
    Bruner B, Breau RH, Lohse CM, Leibovich BC, Blute ML. Renal nephrometry score is associated with urine leak after partial nephrectomy. BJU Int. 2011;108(1):67–72.CrossRefPubMedGoogle Scholar
  61. 61.
    Breau RH, Crispen PL, Jimenez RE, Lohse CM, Blute ML, Leibovich BC. Outcome of stage T2 or greater renal cell cancer treated with partial nephrectomy. J Urol. 2010;183(3):903–8.CrossRefPubMedGoogle Scholar
  62. 62.
    Wang HK, Zhu Y, Yao XD, et al. External Validation of a nomogram using RENAL nephrometry score to predict high grade renal cell carcinoma. J Urol. 2012;187(5):1555–60.CrossRefPubMedGoogle Scholar
  63. 63.
    Satasivam P, Sengupta S, Rajarubendra N, Chia PH, Munshey A, Bolton D. Renal lesions with low R.E.N.A.L nephrometry score are associated with more indolent renal cell carcinomas (RCCs) or benign histology: findings in an Australian cohort. BJU Int. 2012;109(3):44–7.CrossRefPubMedGoogle Scholar
  64. 64.
    Rosevear HM, Gellhaus PT, Lightfoot AJ, Kresowik TP, Joudi FN, Tracy CR. Utility of the RENAL nephrometry scoring system in the real world: predicting surgeon operative preference and complication risk. BJU Int. 2012;109(5):700–5.CrossRefPubMedGoogle Scholar
  65. 65.
    Zbrzezny JM, Yang KK, Alshora S, Amirifeli S, Canes D, Libertino JA. Perioperative outcomes of open and minimally invasive partial nephrectomy stratified. R.E.N.A.L. nephrometry score. Burlington: Department of Urology Lahey Clinic Medical Center. InPress.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Serge Ginzburg
    • 1
    • 2
  • Alexander Kutikov
    • 3
  • Robert G. Uzzo
    • 4
  • Stephen B. Schloss
    • 5
    Email author
  1. 1.Urology Institute of Southeastern Pennsylvania, Einstein Hospital SystemPhiladelphiaUSA
  2. 2.Department of UrologyFox Chase Cancer CenterPhiladelphiaUSA
  3. 3.Division of Urology and Urologic Oncology, Department of UrologyFox Chase Cancer Center, Temple University School of Medicine CenterPhiladelphiaUSA
  4. 4.Department of Surgical Oncology, Division of UrologyFox Chase Cancer Center – Temple University Health SystemPhiladelphiaUSA
  5. 5.Department of UrologyMGH Cancer Center, Emerson HospitalConcordUSA

Personalised recommendations