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Zonal NephRo Score: external validation for predicting complications after open partial nephrectomy

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Abstract

Purpose

The aim of the study was to externally validate the Zonal NePhRO Score (ZNS) published in 2014 as latest and superior nephrometry score in terms of prediction of perioperative complications and outcome of open partial nephrectomies (OPNs).

Methods

We identified 200 consecutive patients who underwent OPN. Analysis of preoperative CT or MRI scans and retrospective analysis of the patients’ clinical records were performed. Tumour complexity was stratified according to the ZNS into three categories: low (4–6), moderate (7–9) and high (10–12) complexity. Predictors for perioperative complications and surgical parameters were identified using univariate and multivariate logistic regression.

Results

Tumour complexity was graded in 19.8 % of the cases as low, in 50.3 % as moderate and in 29.9 % as high. In the multivariate analysis, ZNS was significantly associated with a higher complication rate (OR 1.25, 95 % CI 1.04–1.49, p = 0.014), longer ischaemia time (IT) (β = 1.19, 95 % CI 0.33–2.05, p = 0.007), postoperative drop of estimated glomerular filtration rate (eGFR) (β = −1.86, 95 % CI −3.71 to −0.01, p = 0.049) and opening of the collecting system (CS) (OR 1.72, 95 % CI 1.40–2.10, p < 0.001). In addition, age and body mass index were identified as independent predictors for complications (OR 1.03, 95 % CI 1.00–1.06, p = 0.043 and OR 1.08, 95 % CI 1.00–1.15, p = 0.031).

Conclusion

The present study is the first external validation of the ZNS as a predictor of perioperative complications in patients undergoing OPN. A higher ZNS score was associated with a longer IT, a higher rate of opening the CS and drop of eGFR.

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Authors’ contribution

Conception and design as well as drafting of the manuscript were done by M. C. Kriegmair and D. Pfalzgraf under the supervision of M. S. Michel and C. Bolenz, who also contributed by critical revision of the manuscript for important scientific input. Data were collected by M. C. Kriegmair and A. Moses. Analysis and interpretation of the data were performed by M. C. Kriegmair, D. Pfalzgraf and P. Mandel, who additionally carried out statistical analysis.

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Authors and Affiliations

  1. Department of Urology, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    M. C. Kriegmair, A. Moses, C. Bolenz, M. S. Michel & D. Pfalzgraf

  2. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    P. Mandel

Authors
  1. M. C. Kriegmair
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  2. P. Mandel
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  3. A. Moses
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  4. C. Bolenz
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  5. M. S. Michel
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Corresponding author

Correspondence to M. C. Kriegmair.

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None declared.

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The work has been approved by the local ethics committee (Approval Number 2013-830-MA).

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Kriegmair, M.C., Mandel, P., Moses, A. et al. Zonal NephRo Score: external validation for predicting complications after open partial nephrectomy. World J Urol 34, 545–551 (2016). https://doi.org/10.1007/s00345-015-1648-7

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  • DOI: https://doi.org/10.1007/s00345-015-1648-7

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