Practical and intuitive surgical approach renal ranking to predict outcomes in the management of renal tumors: a novel score tool.
OBJECTIVE
Surgery continues to be the main form of treatment for patients with renal tumors. We create a more practical and intuitive score for renal tumor classification.


METHODS
Eighty patients underwent surgery for renal tumors and were prospectively enrolled. The tumors were classified using the following variables: (1) tumor size, (2) endophytic or exophytic tumor, (3) longitudinal location of the tumor, (4) the extent of the impairment of the renal parenchyma, (5) relationship with the renal sinus, and (6) anterior or posterior.


RESULTS
The mean operative time, tumor size,and bleeding increased proportionally to the increased complexity of the tumor measured by scores (P<0.0001, P<0.0001, and P=0.036, respectively). The mean total score was 8.7 points for patients undergoing partial nephrectomy (PN) and 14.4 points for those undergoing radical nephrectomy (RN) (P<0.0001). Patients with larger tumors, completely endophytic, which exceeded the renal medulla, and were centrally located, underwent RN more often (86.7% - P<0.0001, 64% - P=0.01, 77% - P<0.0001, and 78.9% - P<0.0001, respectively). In univariate analysis, RN was associated with tumors larger than 7 cm (P=0.001), tumors that exceeded the renal medullary (<0.001), centrally located tumors (odds ration [OR]=150, P<0.001), and tumors of high complexity (P<0.001). Analysis showed no association between complications and variables in the score. The findings were similar when the tumors were evaluated with the R.E.N.A.L. score system.


CONCLUSIONS
Surgical Approach Renal Ranking is a simple, practical and intuitive classification for renal tumors that can be used in the decision-making process and to predict outcomes in the surgical treatment of patients with renal tumors.
Division of Urology, Federal University of Sao Paulo , Sao Paulo, Brazil .
Matheus
M
Tannus
Suzan M
SM
Goldman
Cássio
C
Andreoni
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002292:Carcinoma, Renal Cell / Q000145:classification / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D007680:Kidney Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D011446:Prospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult