Clinical-Kidney Cancer Nephrometry and cumulative morbidity after partial nephrectomy: A standardized assessment of complications in the context of PADUA and RENAL scores

Background: Nephrometry scores aid in clinical decision-making, yet evidence is scarce regarding their impact on cumulative morbid-ity following partial nephrectomy (PN). Patients and methods: Retrospective, monocentric study of 122 patients with suspicious renal masses undergoing open or robot-assisted PN between January 2019 and August 2020. Morbidity assessment followed European Association of Urology guidelines on complication reporting. 30-d complications were extracted using a PN-specific catalog, were graded by the Clavien-Dindo classification (CDC), and Comprehensive Complica-tion Index (CCI (R)) values were calculated. The impact of nephrometry on cumulative morbidity was evaluated by (1) comparing morbidity estimates between Preoperative Aspects and Dimensions Used for an Anatomical (PADUA)/R.E.N.A.L. complexity groups, (2) by Pearson's correlation between nephrometry scores and CCI (R), and (3) by multivariable regression models using any 30-d complication and 30-d CCI (R) as endpoints. Results: Of 122 patients, 101 (83%) underwent open and 21 (17%) robot-assisted PN. Median PADUA and R.E.N.A.L. scores were 9 (interquartile range, IQR 8-10) and 8 (IQR 6-9), respectively. Of 218 complications in 92 patients (75%), the majority was classified as minor (CDC grade <= IIIa). Median 30-d CCI (R) was 8.7 (IQR 0.50-15). There was a small positive correlation between PADUA or R.E.N.A.L. score with CCI (R) (all P <= 0.026), explaining 4.7% and 4.1% of the variation in CCI (R), respectively. After adjustment, nephrometry scores were associated with any 30-d complication and the CCI (R) (all P <= 0.011). PADUA and R.E.N.A.L. high complexity tumors were positively associated with both morbidity endpoints compared to low complexity tumors (all P <= 0.041). Conclusions: At a referral center, PN may be safely performed, even if morbidity assessment follows a strict protocol. Nephrometry risk classification does only marginally translate into clinical relevant differences regarding short-term complications. Thus, nephron-sparing surgery should not be withheld from patients with high complexity renal masses.(c) 2022 Elsevier Inc. All rights reserved.