Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
J Endourol. 2011 Aug;25(8):1315-21. doi: 10.1089/end.2011.0072. Epub 2011 Jul 11.
We retrospectively reviewed the preoperative radiologic findings and operational videos of a group of patients who were undergoing laparoscopic nephron-sparing surgery (NSS), to determine whether we should decide the operational approach (laparoscopic vs open or radical nephrectomy) on the basis of only the preoperative aspects and dimensions used for an anatomic (PADUA) classification.
In total, 41 laparoscopic NSS operations were performed during a 34-month period for suspicious solid renal lesions. Clinicopathologic variables, PADUA scores, operative parameters, and renal functional outcomes were prospectively recorded and analyzed. Meanwhile, a similar classification (intraoperative aspects and dimensions used for an anatomic [IADUA] classification) was used to compare the preoperative imaging modality findings with intraoperative findings.
There was a 73.2% difference between PADUA and IADUA scores. Sixteen (39%) patients had PADUA scores >IADUA scores, 14 (34%) had PADUA scores <IADUA scores, and only 11 (27%) had similar PADUA and IADUA scores. For the study cohort, the mean operative time (OT) was 128 minutes (range 50-250) min, the mean estimated blood loss (EBL) was 199 mL (range 10-1000 mL), the mean warm ischemia time was 35.2 minutes (range 15-60 min), and the mean change in glomerular filtration rate was 8.17 mL/min/1.73m(2) (range -41-26 mL/min/1.73m(2)). The mean pathologic tumor size was 32.7±12.3 mm. Thirteen complications were recorded according to the modified Clavien system. PADUA and IADUA were not correlated with EBL and OT, and higher scores failed to predict perioperative complications.
Reproducible standardized classification systems are necessary for renal masses. Intraoperative findings for renal masses, however, may differ from the preoperative radiologic evaluation. Thus, the decision for the type of surgical approach should not be based solely on preoperative assessment, such as the PADUA score.
我们回顾性分析了一组接受腹腔镜肾部分切除术（NSS）患者的术前影像学表现和手术视频，以确定是否仅根据术前解剖学（PADUA）分类的方面和维度来决定手术方法（腹腔镜与开放或根治性肾切除术）。
在 34 个月的时间内，共对 41 例疑似肾脏占位性病变的患者行腹腔镜 NSS 手术。前瞻性记录并分析了临床病理变量、PADUA 评分、手术参数和肾功能结果。同时，采用类似的分类方法（用于解剖的术中方面和维度分类[IADUA]）比较术前影像学检查结果与术中结果。
PADUA 评分与 IADUA 评分相差 73.2%。16 例（39%）患者的 PADUA 评分>IADUA 评分，14 例（34%）患者的 PADUA 评分<IADUA 评分，仅有 11 例（27%）患者的 PADUA 评分与 IADUA 评分相似。对于研究队列，平均手术时间（OT）为 128 分钟（范围 50-250 分钟），平均估计失血量（EBL）为 199 毫升（范围 10-1000 毫升），平均热缺血时间为 35.2 分钟（范围 15-60 分钟），肾小球滤过率变化平均为 8.17 毫升/分钟/1.73 平方米（范围-41-26 毫升/分钟/1.73 平方米）。平均病理肿瘤大小为 32.7±12.3 毫米。根据改良的 Clavien 系统记录了 13 种并发症。PADUA 和 IADUA 与 EBL 和 OT 不相关，较高的评分并不能预测围手术期并发症。
对于肾脏肿块，需要使用可重复的标准化分类系统。然而，肾脏肿块的术中表现可能与术前影像学评估不同。因此，手术方式的选择不应仅基于术前评估，如 PADUA 评分。
