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A three-dimensional, anatomy-based nephrometry score to guide nephron-sparing surgery for renal sinus tumors.

Authors
  • Huang, Qingbo1
  • Gu, Liangyou1
  • Zhu, Jie1
  • Peng, Cheng1
  • Du, Songliang1
  • Liu, Qiming1
  • Chen, Jianwen1
  • Wang, Baojun1
  • Fan, Yang1
  • Gao, Yu1
  • Fam, Xenginn2
  • Wang, Haiyi3
  • Liu, Fengyong4
  • Guo, Aitao5
  • Li, Hongzhao1
  • Zhang, Xu1
  • Ma, Xin1
  • 1 Department of Urology, Chinese People's Liberation Army (PLA) General Hospital/PLA Medical School, Beijing, China. , (China)
  • 2 Urology Unit, Department of Surgery, Kebangsaan Malaysia University Medical Center, Kuala Lumpur, Malaysia. , (Malaysia)
  • 3 Department of Radiology, Chinese PLA General Hospital/PLA Medical School, Beijing, China. , (China)
  • 4 Department of Interventional Radiology, Chinese PLA General Hospital/PLA Medical School, Beijing, China. , (China)
  • 5 Department of Pathology, Chinese PLA General Hospital/PLA Medical School, Beijing, China. , (China)
Type
Published Article
Journal
Cancer
Publisher
Wiley (John Wiley & Sons)
Publication Date
May 01, 2020
Volume
126 Suppl 9
Pages
2062–2072
Identifiers
DOI: 10.1002/cncr.32748
PMID: 32293724
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

A quantitative nephrometry scoring system specifically for renal sinus tumors will assist in classifying surgical complexity and treatment planning. By using preoperative computed tomography, magnetic resonance imaging, and 3-dimensional image reconstruction, 5 critical components were assessed: the ratio of the sinus area occupied by the tumor in relation to the whole sinus area (R), the compression of the renal segmental vessels or collection system by the tumor (O), the anteroposterior relation of the tumor relative to the segmental vessels or collection system (A), the tumor diameter (D), and whether the tumor affects a solitary kidney (S) ("ROADS"). The ROADS score, indicating low, moderate, or high surgical complexity, was then used to guide surgical strategy planning, including cooling techniques, surgical approaches, and parenchyma incision techniques. A cohort of 134 patients with renal sinus tumors was treated based on their ROADS score and was retrospectively analyzed. The authors successfully performed 113 nephron-sparing surgeries and 21 radical nephrectomies with a complication rate of 7.9%. During follow-up, 3 cases were classified according to surgical margin status because they lacked an intact tumor capsule. There was only 1 case of local recurrence, and there were no cases of metastasis. A high ROADS score was correlated with greater operative complexity, such as longer operation and ischemia times and higher estimated blood loss and complication rates. However, renal function and short-term oncologic outcomes were not related to the score. The ROADS scoring system provides a standardized, quantitative, 3-dimensional anatomic classification to guide surgical strategy in renal sinus tumors. © 2020 American Cancer Society.

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