Clinical value of diameter-axial-polar scoring system in retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma

doi:10.3877/cma.j.issn.1674-0785.2021.04.004

Abstract

Abstract:

Objective

To investigate the clinical value of the diameter-axial-polar (DAP) scoring system in retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma.

Methods

The clinical data of 119 patients with renal cell carcinoma who underwent retroperitoneal laparoscopic partial nephrectomy at Department of Urology, Huai'an Hospital Affiliated to Xuzhou Medical University from January 2016 to December 2019 were retrospectively analyzed. According to the DAP scoring system, they were divided into three groups: low complexity group, moderate complexity group, and high complexity group. The operation time, intraoperative blood loss, intraoperative warm ischemia time, postoperative hospital stay, postoperative serum creatinine changes, and postoperative complications were compared among the groups.

Results

Among the 119 patients, 40 were in the low complexity group, 58 in the moderate complexity group, and 21 in the high complexity group. There were no significant differences in age, gender, preoperative serum creatinine level, or body mass index among the three groups (P＞0.05). With the increase of complexity, the operation time, warm ischemia time, and blood loss also signficantly increased (P＜0.05), but postoperative hospital stay and serum creatinine level had no significant change (P＞0.05). In terms of complications, the incidence of complications increased with the increase of complexity (P＜0.05), and the risk of postoperative complications in the high complexity group was 11.69 times higher than that in the low complexity group (odds ratio =11.69, 95% confidence interval: 2.19-62.27, P=0.004). However, there was no significant difference in the Clavien classification of complications among different groups (P＞0.05). The accuracy of DAP scoring system in predicting postoperative complications was high (area under the curve = 0.725, P=0.004), and the sensitivity and specificity were 87.5% and 63.1%, respectively.

Conclusion

The DAP scoring system in retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma has good clinical application value in predicting the complexity of tumor, the difficulty of operation, and the risk of postoperative complications.

Key words: Diamete-axial-polar scoring system, Kidney neoplasms, Partial nephrectomy, Laparoscopy

Sugui Wang, Lu Zhang, Fujin Jiang, Qiang Li, Ziyu Wu, Xianyun Zhang. Clinical value of diameter-axial-polar scoring system in retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(04): 255-259.

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Figures/Tables 3

组别	例数	性别（例）		年龄（岁， $x ¯$ ±s）	BMI（kg/m²， $x ¯$ ±s）	术前血肌酐（μmol/L， $x ¯$ ±s）
组别	例数	男	女	年龄（岁， $x ¯$ ±s）	BMI（kg/m²， $x ¯$ ±s）	术前血肌酐（μmol/L， $x ¯$ ±s）
低度复杂组	40	22	18	51.8±4.1	25.9±3.6	72.1±2.4
中度复杂组	58	32	26	50.9±2.4	26.1±2.7	72.9±2.1
高度复杂组	21	13	8	51.4±1.9	25.4±3.6	73.2±1.9
统计值		χ²=0.32		F=1.39	F=2.11	F=1.94
P值		P=0.849		P=0.214	P=0.392	P=0.517

组别	例数	性别（例）		年龄（岁， $x ¯$ ±s）	BMI（kg/m²， $x ¯$ ±s）	术前血肌酐（μmol/L， $x ¯$ ±s）
组别	例数	男	女	年龄（岁， $x ¯$ ±s）	BMI（kg/m²， $x ¯$ ±s）	术前血肌酐（μmol/L， $x ¯$ ±s）
低度复杂组	40	22	18	51.8±4.1	25.9±3.6	72.1±2.4
中度复杂组	58	32	26	50.9±2.4	26.1±2.7	72.9±2.1
高度复杂组	21	13	8	51.4±1.9	25.4±3.6	73.2±1.9
统计值		χ²=0.32		F=1.39	F=2.11	F=1.94
P值		P=0.849		P=0.214	P=0.392	P=0.517

组别	例数	手术时间（min， $x ¯$ ±s）	术中热缺血时间（min， $x ¯$ ±s）	术中出血量（ml， $x ¯$ ±s）	术后血肌酐（μmol/L， $x ¯$ ±s）	术后住院时间（d， $x ¯$ ±s）	并发症［例（%）］
低度复杂组	40	86.2±9.8	12.3±2.1	48.6±7.2	73.1±3.6	8.3±1.8	2（5.0）
中度复杂组	58	90.1±10.2	15.8±6.8	52.8±8.2	72.7±2.8	8.5±1.6	6（10.3）
高度复杂组	21	118.3±11.2	23.4±7.1	71.6±9.7	73.6±1.3	8.8±2.2	8（38.1）
统计值		F=28.86	F=12.58	F=38.06	F=0.81	F=1.85	χ²=13.90
P值		0.002	0.005	0.001	0.281	0.836	0.001

组别	例数	手术时间（min， $x ¯$ ±s）	术中热缺血时间（min， $x ¯$ ±s）	术中出血量（ml， $x ¯$ ±s）	术后血肌酐（μmol/L， $x ¯$ ±s）	术后住院时间（d， $x ¯$ ±s）	并发症［例（%）］
低度复杂组	40	86.2±9.8	12.3±2.1	48.6±7.2	73.1±3.6	8.3±1.8	2（5.0）
中度复杂组	58	90.1±10.2	15.8±6.8	52.8±8.2	72.7±2.8	8.5±1.6	6（10.3）
高度复杂组	21	118.3±11.2	23.4±7.1	71.6±9.7	73.6±1.3	8.8±2.2	8（38.1）
统计值		F=28.86	F=12.58	F=38.06	F=0.81	F=1.85	χ²=13.90
P值		0.002	0.005	0.001	0.281	0.836	0.001

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