ABSTRACT
AIM: The purpose of the study is the development and evaluation of the informativeness of the author's 3D nephrometric score application to predict the probability of intraoperative and postoperative complications in kidney operations. MATERIAL AND METHODS: The study includes 264 patients who underwent surgical treatment of renal tumors, before that CT and 3D modeling were carried out. All patients underwent an analysis of the surgical intervention complexity on the C-index, PADUA, R.E.N.A.L., and developed 3D nephrometric score. To determine the set of variables that allow to classify patients, the method of discriminant analysis was used to predict the nature, volume of blood loss, duration of ischemia, and the number of complications. The sensitivity and specificity of the predictors were estimated with the help of ROC analysis. RESULTS: Indicators have been established to classify patients according to the probability of complications, the amount of blood loss and the duration of ischemia during surgery for kidney cancer. We have created linear models that predict the development of bleeding during surgery, the volume of blood loss of more than 200 ml and the duration of ischemia more than 20 min, as well as the likelihood of complications using discriminant functions. The proposed author's nephrometric score exceeds the capabilities of C-index, PADUA, R.E.N.A.L in many ways in blood loss and time of ischemia predicting, which allows us to recommend it for the assessment of resectability in kidney operations.
Subject(s)
Kidney Neoplasms , Nephrectomy , Female , Humans , Kidney/surgery , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery , Male , Nephrectomy/methods , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Probability , Retrospective StudiesABSTRACT
PURPOSE: whilst renal scintigraphy (RS) can be associated with interobserver variability, it remains the standard method of evaluating split renal function. AIM: to compare the efficacy of the novel technique of kidney function assessment and renal scintigraphy. METHOD: for this prospective single-arm study we recruited patients who were recommended dynamic renal scintigraphy with 99mTc-DTPA (diethylenetriaminepentacetate). After scintigraphy, mathematical analysis of computed tomography (MACT) was done in all patients, by a single person (SK) blinded to RS results. RESULTS: the study included a total of 97 patients with mean age of 50.9 (range, 23-78) years. From this sample, 65 were females and 32 males. All patients underwent both RS and contrast-enhanced computed tomography for further MACT in 2016-2018. CT results were found to be similar to renal scintigraphy results with Pearson correlation coefficient of 0.945 (Ñ < 0.001). Substantial similarities in renal plasma flow for both kidneys were also observed (0.815, Ñ < 0.001). CONCLUSION: MACT proved feasible, effective and safe in estimating renal function. Its results are closely correlated with RS findings and could be easily integrated into surgical practice.
Subject(s)
Contrast Media , Kidney/diagnostic imaging , Kidney/physiopathology , Radiographic Image Enhancement/methods , Tomography, X-Ray Computed/methods , Tomography, X-Ray Computed/statistics & numerical data , Adult , Aged , Female , Glomerular Filtration Rate , Humans , Kidney Function Tests/methods , Kidney Function Tests/statistics & numerical data , Male , Middle Aged , Models, Biological , Models, Theoretical , Observer Variation , Prospective Studies , Radionuclide Imaging/methods , Radionuclide Imaging/statistics & numerical data , Reproducibility of Results , Young AdultABSTRACT
Contrast-enhanced multi-slice computed tomography (MSCT) is commonly used in the diagnosis of complex malignant tumours. This technology provides comprehensive and accurate information about tumour size and shape in relation to solid tumours and the affected adjacent organs and tissues. This case report demonstrates the benefit of using MSCT 3D imaging for preoperative planning in a patient with late-stage (T4) sarcomatoid renal cell carcinoma, a rare renal malignant tumour. The surgical margin on the liver was negative, and no metastases to veins, lungs or other organs were detected by abdominal and chest contrast-enhanced CT. Although sarcomatoid histology is considered to be a poor prognostic factor, the patient is alive and well 17 months after surgery. The MSCT imaging modality enables 3D rendering of an area of interest, which assists surgical decision-making in cases of advanced renal tumours. In this case, as a result of MSCT 3D reconstruction, the patient received justified surgical treatment without compromising oncological principles.
