A CLINICAL STUDY TO ASSESS THE COMPLEXITY OF NEPHRON SPARING SURGERY USING DIFFERENT SCORING SYSTEMS

Abstract

Renal cell carcinoma accounts for about 3.5% of all malignancies in the body, and is ranked the third most common cancer of the urinary tract (1) . With increased use of imaging, most of the renal tumors are detected incidentally; incidentally detected small renal masses constitute 48% to 66% of overall renal cell carcinoma (RCC) diagnosis(2). Surgical management of either partial or total nephrectomy results in a 99.2% recurrence-free survival rate (3) Partial nephrectomy or nephron-sparing surgery (NSS) is considered the treatment of choice for localized small renal masses with oncological outcome comparable to radical nephrectomy (RN) (4). The
use of NSS has an advantage of preserving renal function with lower cardiovascular mortality and morbidity (5, 6) . Partial nephrectomy (PN) is the gold standard for T1a and T1b. Even for T2 masses, it should be given preference over radical nephrectomy if it is technically possible (7, 8). Partial nephrectomy is also strongly preferred whenever preservation of renal function is potentially important. This is applicable in cases such as patients with pre-existing chronic kidney disease, those with an abnormal contra lateral kidney, or those with multifocal or familial renal cell carcinoma (10). Partial nephrectomy can be performed by open partial nephrectomy, laparoscopic partial nephrectomy and robotic partial nephrectomy. A meta-analysis of 9 studies by Kim et al (9), revealed the following statistically significant results in favour of Partial Nephrectomy:
1. 61% risk reduction for the development of severe Chronic kidney disease
2. 19% risk reduction in overall mortality
3. 29% risk reduction in cancer-specific mortality