515 OBJECTIFYING SURGICAL DECISION-MAKING FOR THE ENHANCING RENAL MASS (2010)

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging I1 Apr 2010515 OBJECTIFYING SURGICAL DECISION-MAKING FOR THE ENHANCING RENAL MASS Daniel Canter, Alexander Kutikov, Brandon Manley, Brian Egleston, Deb Kister, Stephen A. Boorjian, Rosalia Viterbo, David Y.T. Chen, Richard E. Greenberg, and Robert G. Uzzo Daniel CanterDaniel Canter More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Brandon ManleyBrandon Manley More articles by this author , Brian EglestonBrian Egleston More articles by this author , Deb KisterDeb Kister More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , David Y.T. ChenDavid Y.T. Chen More articles by this author , Richard E. GreenbergRichard E. Greenberg More articles by this author , and Robert G. UzzoRobert G. Uzzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.591AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite the release of recent guidelines for the treatment of localized RCC [1], surgical decision making remains overly subjective. The Nephrometry Score (NS) characterizes salient renal mass anatomy in a reproducible and quantifiable manner, allowing standardization and comparison of outcomes. We evaluate our patterns of treatment as they reflect a tumor's Nephrometry Score. METHODS Nephrometry scores were available in 405/1650 in our kidney tumor database (2000-2009) who underwent RN or PN. We used Fisher's Exact tests, T-tests, multiple linear regressions, and exact binomial tests of equal proportions to define the most predictive components of Nephrometry (largest coefficients of determination (R2) from linear regressions). RESULTS Of the 405 evaluable patients, surgical treatments included minimally-invasive partial nephrectomy (MIS-PN) (n=110 (27%)) open PN (OPN) (n=120 (30%)), MIS radical nephrectomy (MIS-RN) (n=134 (33%)), and open RN (ORN) (n=41 (10%)). Table 1 illustrates the likelihood of a given procedure based on Nephrometry. Higher nephrometry was associated with open/radical procedures (mean Nephrometry score MIS-PN=6.8 (range=4-11, sd 1.8), MIS-RN=9.4 (range=4-12, sd 1.5), OPN=8.2 (range=4-12, sd 1.8), ORN=9.7 (range=6-11, sd 1.2)) (p<0.0001). A higher numerical ‘R' (tumor size) score was most predictive of RN versus a NSS (R2=0.35, p<0.0001). Similarly, a lower ‘N' (nearness to sinus/urothelium) score was most predictive of MIS-PN versus OPN (R2=0.02, p=0.006). Among tumors undergoing NSS, a large tumors size (R=3(>7cm)) best predicted OPN (87%) vs MIS-PN (13%) while a difficult location (L=3(between polar lines) showed the smallest predictive ability (57% OPN vs 43% MIS-PN). Among tumors undergoing RN, endophycity (E=3 (completely intrarenal)) was most predictive of an MIS-RN (91%) vs. ORN (9%). Overall, the tumor size component (‘R' score) correlated most (R2=0.40) and the endo/exophytic (‘E' score) correlated the least (R2=0.05) with surgical type. Table 1. Surgical Approach Stratified by Nephrometry Score Complexity Low Score 4-6 (n/col%) Moderate Score 7-9 (n/col%) High Score 10-12 (n/col%) Radical Nephrectomy Laparoscopic (n=120) 7 (9%) 47(26%) 66(46%) Open (n=41) 1(1%) 7(4%) 33(23%) Partial Nephrectomy Robotic (n=110) 52(63%) 48(27%) 10(7%) Open (n= 134) 22(27%) 77(43%) 35(24%) Total (n=405) 82(100%) 179(100%) 144(100%) *Suffix ‘A' and ‘P' were associated with PN (p<0.001). Among those PN with ‘A', an anterior location was not a statistically significant predictor of MIS versus open (p=1.0). In contradistinction, ‘P' predicted for an open approach (p=0.03). CONCLUSIONS Objectifying decision making using Nephrometry may help standardize surgical procedure selection as well as reporting in the RCC literature. References [1] : Guideline for management of the clinical T1 renal mass. Journal of Urology2009 October; 182: 1271. Link, Google Scholar Philadelphia, PA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e203-e204 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Canter More articles by this author Alexander Kutikov More articles by this author Brandon Manley More articles by this author Brian Egleston More articles by this author Deb Kister More articles by this author Stephen A. Boorjian More articles by this author Rosalia Viterbo More articles by this author David Y.T. Chen More articles by this author Richard E. Greenberg More articles by this author Robert G. Uzzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...