Comparing technology-based scoring systems for retroperitoneoscopic partial nephrectomy

Abstract

Nephrometry scores play a critical role in the preoperative evaluation of partial nephrectomy. Although score comparisons have been performed for transperitoneal or open surgery, systematic comparisons for retroperitoneal operations are lacking. Authors have retrospectively evaluated the clinical records of patients who underwent partial nephrectomy at one center by one surgeon. Scores were generated according to the imaging results, and each score was categorized into low-, intermediate- and high-complexity groups. Then, the differences in perioperative outcomes were compared among the groups. We assessed whether the scores and sex, body mass index (BMI), age, or American Society of Anesthesiologists (ASA) Physical Status classification could predict whether the warm ischemia time (WIT) was likely be longer than 20 min and whether they could predict postoperative complications worse than Clavien–Dindo 1. The interobserver variability between two experienced surgeons for these scores was calculated with the intraclass correlation coefficient (ICC). Total of 107 patients were ultimately evaluated. The scores included in this study were significantly associated with the probability of having a WIT > 20 min and high-grade postoperative complications. Receiver Characteristic Operator (ROC) curves showed that there were no significant differences in their predictive power. NePhRo had the highest agreement (0.839), followed by DAP (0.827). RENAL was superior to SPARE and PADUA, which were 0.758, 0.724 and 0.667, respectively.