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ORIGINAL ARTICLE
Year : 2020  |  Volume : 31  |  Issue : 4  |  Page : 156-162

Comparing the predictive values of diameter-axial-polar and renal scores for long-term trifecta outcomes in robot-assisted partial nephrectomy for renal cell carcinoma


1 Department of Urology, National Taiwan University Hospital, Taipei; Department of Surgery, Division of Urology, Camillians Saint Mary's Hospital, Luodong, Taiwan
2 Department of Urology, National Taiwan University Hospital, Taipei; Department of Urology, Medical Research and Education, Taipei Veterans General Hospital, YuanShan Branch, YiLan; Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, Taipei, Taiwan
3 Department of Urology, National Taiwan University Hospital, Taipei, Taiwan

Correspondence Address:
Chao Yuan Huang
No. 7, Chung Shan S. Road (Zhongshan S. Road), Zhongzheng District, Taipei City 10002
Taiwan
Chi Chih Lien
No. 7, Chung Shan S. Road (Zhongshan S. Road), Zhongzheng District, Taipei City 10002
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/UROS.UROS_81_19

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Purpose: Few studies have reported the value of the diameter-axial-polar (DAP) score in robot-assisted partial nephrectomy (RaPN) for renal cell carcinoma (RCC) and sequentially compare DAP and RENAL nephrometry score to predict long-term surgical, oncological, and functional outcomes of RaPN for renal cancer. This study demonstrated that the DAP score is effective enough to predict long-term trifecta outcomes of RaPN. Materials and Methods: We retrospectively collected clinical data of 108 patients with pathologically confirmed RCC who received RaPN by a single surgeon during 2012–2017. The patients were stratified into low, intermediate, and high complexities according to the RENAL and DAP scoring systems. We analyzed warm ischemia time (WIT), cancer-specific survival, radiographic progression-free survival, positive rate of surgical margin, renal function from the preoperative period to postoperative 1st/6th month, and postoperative complications. Results: The median follow-up period was 36 months. The 3-year cancer-specific survival rate and 3-year radiographic progression-free survival were 98.4% and 95.2%, respectively. Four patients (3.6%) had positive surgical margins. The largest decrease of renal functions from pre- to postoperative 6th month was noted in the intermediate DAP score group. No difference was observed between the DAP and RENAL scores in terms of WIT in 25 min, positive margin, complication, 3-year radiographic local recurrence, and chronic kidney disease (CKD) change, but a significant difference was observed in WIT in 20 min (area under the curve of DAP vs. RENAL = 0.81 vs. 0.54, P = 0.03). Age is an independent factor for progression to CKD after RaPN (odds ratio = 1.054, 95% confidence interval = 1.008–1.102, P = 0.022). Complications occurred in 22 patients (20.4%), and the most common postoperative complications were bleeding (12.2%), postoperative fever (0.5%), and urinary leakage (0.3%). Conclusion: The DAP score is an easy and effective tool for predicting perioperative outcomes of RaPN, especially in WIT in 20 min.


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