External validation of the ABC scoring system in minimally invasive partial nephrectomy / 中国肿瘤临床

Objective: To assess the role of the arterial based complexity (ABC) scoring system in predicting clinically relevant outcomes of minimally invasive partial nephrectomy (MIPN). Methods: A retrospective review of 161 renal cell carcinoma patients who under-went MIPN at Tianjin Medical University Cancer Institute and Hospital from June 2016 to January 2018 was performed. The ABC score, including grades 1, 2, 3S, and 3H, were based on the patients'enhanced preoperative abdominal CT images. The reproducibility of the ABC scoring system was evaluated, and the relationship between the ABC score and patients'pathological features, surgery-related variables, postoperative complications, and renal function was analyzed. Results: Patients in grades 1, 2, 3S, and 3H in this study ac-counted for 20.5% (33/161), 60.2% (97/161), 11.8% (19/161), and 7.5% (12/161), respectively. The average Kappa value of the physi-cian's score was 0.523, and the average exact match percentage was 70.2%. The ABC score was significantly associated with operative time, warm ischemia time (WIT), estimated blood loss (EBL), and tumor size (P<0.001 for all) and was not associated with postopera-tive hospital stay, postoperative complications, preoperative estimated glomerular filtration rate (eGFR), and eGFR at 3 and 6 months postoperatively (P>0.05 for both). Conclusions: The ABC score is a scoring system with good repeatability and has certain predictive significance for the complexity of MIPN. However, further research is needed for its clinical application.

Comparison of Renal Function between Robot-Assisted and Open Partial Nephrectomy as Determined by Tc 99m-DTPA Renal Scintigraphy

We compared postoperative renal function impairment between patients undergoing robot-assisted partial nephrectomy (RAPN) and those undergoing open partial nephrectomy (OPN) by using Tc-99m diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy. Patients who underwent partial nephrectomy by a single surgeon between 2007 and 2013 were eligible and were matched by propensity score, based on age, tumor size, exophytic properties of tumor, and location relative to the polar lines. Of the 403 patients who underwent partial nephrectomy, 114 (28%) underwent RAPN and 289 (72%) underwent OPN. Mean follow-up duration was 35.2 months. Following propensity matching, there were no significant differences between the two groups in tumor exophytic properties (P = 0.818) or nephrometry score (P = 0.527). Renal ischemic time (24.4 minutes vs. 17.8 minutes, P < 0.001) was significantly longer in the RAPN group than in the OPN group, while the other characteristics were similar. Multivariate analysis showed that greater preoperative renal unit function (P = 0.011) and nephrometry score (P = 0.041) were independently correlated with a reduction in glomerular filtration rate. The operative method did not correlate with renal function impairment (P = 0.704). Postoperative renal function impairment was similar between patients who underwent OPN and those who underwent RAPN, despite RAPN having a longer ischemic time.