ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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УЖМБС 2020, 5(1): 29–36
Medicine. Reviews

Assessment of Complexity of Organ preserving Surgery of Kidney Tumors, Systems and Scales of Nephrometry

Khareba G. G., Lesovoy V. N., Schukin D. V.

Organ preserving surgery for kidney tumors is gaining popularity with the purpose of preserving kidney function and avoiding comorbidities associated with kidney failure. Considering the satisfactory technical, oncological and functional results of organ preserving surgery of locally advanced kidney tumors, its use is increasing annually on the background of improvements in surgical technique and experience gained by surgeons. Technical feasibility of performing organ preserving surgery, its complexity, its possible complications, and its usefulness in general depend on a large number of factors. The usage of objective and reproducible techniques prevents the subjectivity of evaluation of the surgical situation and allows standardization of treatment tactics. Thus, nephrometry scales are used to provide the urologist with information about the complexity of future surgery on the anatomic and topographic characteristics of parenchymal tumors of the kidney and help determine the type of surgery. The article presents a comparative overview of modern RENAL, PADUA, C-index and "contact surface area" nephrometry systems. These nephrometric systems are similarly effective for risk prediction. Organ preserving surgery correlates with blood loss, duration of surgery, time of renal ischemia, number of complications, duration of inpatient treatment, time of renal ischemia, and conversion of organ preserving surgery to nephrectomy. All nephrometric systems correlate well with each other, but the data suggest that the "contact surface area" may be a more accurate system in predicting perioperative complications. Nephrometry also correlates with post-operative renal function and some systems are capable of predicting the malignancy of the renal neoplasm and are associated with differentiation and subtype of renal cancer. Nephrometric systems are effective in calculating done by urologists-surgeons regardless of radiologists. Nephrometry systems have become a standardized tool but are not widely used by radiologists. Interdisciplinary agreement between urologists and radiologists can be improved by developing new nephrometric systems. Prospective studies are now being conducted in this area. Conclusion. None of the current nephrometric systems can be considered perfect and studies are continuing in this regard. It is determined that the volume of stored kidney parenchyma after organ preserving surgery is a significant indicator for choosing the tactics of surgical treatment of patients. The use of nephrometry systems should be recommended to determine the complexity of the tumor when planning organ preserving kidney surgery, although international recommendations for organ preserving surgery are still based on the clinical size of the tumor. Although nephrometric systems are similarly effective, none of them fully meet the needs of urologists involved in organ preserving renal tumor surgery, and further research is needed in this area.

Keywords: kidney tumors, organ preserving surgery, nephrometric systems

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