Published date: Dec 29 2023

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 18 (2023), Issue No. 4

Pages: 510–524

DOI: 10.18502/sjms.v18i4.14738

Muzafr Shakir Ali Yousifalmuzaffar.ms@gmail.comGezira Hospital for Renal Diseases and Surgery, Gezira State, Wad-madani, Sudan

Ahmed Shakir Ali YousifGezira Hospital for Renal Diseases and Surgery, Gezira State, Wad-madani, Sudan

Marwa Gamal AbdelmagidDivision of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN

Yassin Mohammed OsmanDepartment of Surgery, Faculty of Medicine, University of Gezira, Wad-madani, Sudan

Sami Mahjoub TahaDepartment of Surgery, Faculty of Medicine, University of Gezira, Wad-madani, Sudan

Background: Adult renal cell carcinomas account for 80–85% of all renal tumors, making them the most common primary renal tumors. As a method for categorizing renal masses by anatomical characteristics, R.E.N.A.L score is suggested to study the effect on surgical approach in addition to perioperative outcomes and complications.

Methods: A cross-sectional prospective hospital-based study enrolled 48 RCC patients in GHRDS in the period between September 2020 and September 2021. Data regarding demographics, histological subtypes, surgical approach, intraoperative and postoperative complications were collected. Based on R.E.N.A.L score, the complexity of renal tumors is grouped into low, moderate, and high.

Results: The study sample size was 48. Twenty-five participants (52.1%) were men with a mean age of 51 years. Most cases had clear cell RCC 22 (45.8%) and papillary RCC 19 (39.6%). Thirty-nine (81.5%) patients underwent radical nephrectomy (flank incision [extraperitoneal] in 32 [82.1%] and midline incision [transperitoneal] in 7 [17.3%]), and 9 (18.5%) patients underwent partial nephrectomy. One-third of the patients 15 (31.2%) had intraoperative complications and 7 (14.6%) had postoperative complications. All intraoperative and most postoperative complications were associated with radical nephrectomy (P = 0.001). According to complexity, 21 (43.8%) patients had moderate complexity, 15 (31.2%) high complexity, and 12 (25%) low complexity.

Conclusion: Most RCC patients had moderate complexity and were subjected to radical nephrectomy. High complexities were linked to the decision of radical nephrectomy, and intraoperative and postoperative complications. More prospective research with large sample size and multi-centered studies is essential to ensure the generalizability of study findings.

Keywords: Renal Cell Carcinoma, Gezira Hospital for Renal Diseases and Surgery, Sudan, R.E.N.A.L nephrometry scoring system

[1] Camacho, J. C., Kokabi, N., Xing, M., Master, V. A., Pattaras, J. G., Mittal, P. K., & Kim, H. S. (2015). R.E.N.A.L. (Radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines) nephrometry score predicts early tumor recurrence and complications after percutaneous ablative therapies for renal cell carcinoma: A 5-year experience. Journal of Vascular and Interventional Radiology, 26(5), 686–693. https://doi.org/10.1016/j.jvir.2015.01.008

[2] Shin, S. J., Ko, K. J., Kim, T. S., Ryoo, H. S., Sung, H. H., Jeon, H. G., Jeong, B. C., Seo, S. I., Lee, H. M., Choi, H. Y., & Jeon, S. S. (2015). Trends in the use of nephron-sparing surgery over 7 years: An analysis using the R.E.N.A.L. Nephrometry Scoring System. PLoS One, 10(11), e0141709.

[3] Gill, I. S., Kavoussi, L. R., Lane, B. R., Blute, M. L., Babineau, D., Colombo, J. R., Jr., Frank, I., Permpongkosol, S., Weight, C. J., Kaouk, J. H., Kattan, M. W., & Novick, A. C. (2007). Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. The Journal of Urology, 178(1), 41–46.

[4] Leslie, S., Gill, I., de Castro Abreu, A., Rahmanuddin, S., Gill, K., Nguyen, M., Berger, A. K., Goh, A. C., Cai, J., Duddalwar, V. A., Aron, M., & Desai, M. M. (2014). Renal tumor contact surface area: A novel parameter for predicting complexity and outcomes of partial nephrectomy. European Urology, 66(5): 884–893.

[5] Zini, L., Patard, J., Capitanio, U., Mejean, A., Villers, A., de La Taille, A., Ficarra, V., Crepel, M., Bertini, R., Salomon, L., Verhoest, G., Perrotte, P., Bensalah, K., Arjane, P., Biserte, J., Montorsi, F., & Karakiewicz, P. (2009). The use of partial nephrectomy in European tertiary care centers. European Journal of Surgical Oncology (EJSO); 35(6):636-642.

[6] Soares, J. P., Costa-Matos, A., Toledo, L. G. M., Juveniz, J., & Dall Oglio, M. (2018). High R.E.N.A.L. nephrometry score is associated with partial to total nephrectomy conversion, in treatment of renal cancer. Surgery and Rehabilitation, 2(2).

[7] Yeon, J., Son, S., Lee, Y., Cha, W., Choi, W., Chung, J., et al. (2014).The nephrometry score: Is it effective for predicting perioperative outcome during robot-assisted partial nephrectomy? Korean Journal of Urology; 55(4): 254.

[8] Roushias, S., Vasdev, N., Ganai, B., Mafeld, S., Rix, D., Thomas, D., & Soomro, N. (2013). Can the R.e.N.a.L nephrometry score preoperatively predict postoperative clinical outcomes in patients undergoing open and laparoscopic partial nephrectomy? Current Urology, 7(2), 90–97. https://doi.org/10.1159/000356255

[9] SalihYahia, M., Mustafa, O., & Mohammed, E. (2013). Pattern and presentation of renal cell carcinoma in gezira hospital for renal diseases and surgery. Global Journal of Medical Research, 12(2). Advance online publication. https://doi.org/10.1159/000356255

[10] Siegel, R. L., Miller, K. D., & Jemal, A. (2020). Cancer statistics, 2020. CA: A Cancer Journal for Clinicians, 70(1), 7–30. https://doi.org/10.3322/caac.21590

[11] Reddy, U. D., Pillai, R., Parker, R. A., Weston, J., Burgess, N. A., Ho, E. T., Mills, R. D., & Rochester, M. A. (2014). Prediction of complications after partial nephrectomy by RENAL nephrometry score. Annals of the Royal College of Surgeons of England, 96(6), 475–479. https://doi.org/10.1308/003588414X13946184903522

[12] Moch, H., Cubilla, A. L., Humphrey, P. A., Reuter, V. E., & Ulbright, T. M. (2016). The 2016 WHO classification of tumours of the urinary system and male genital organs-Part A: Renal, penile, and testicular tumours. European Urology, 70(1), 93– 105. https://doi.org/10.1016/j.eururo.2016.02.029

[13] Patard, J., Leray, E., Rioux-Leclercq, N., Cindolo, L., Ficarra, V., Zisman, A., De La Taille, A., Tostain, J., Artibani, W., Abbou, C. C., Lobel, B., Guillé, F., Chopin, D. K., Mulders, P. F. A., Wood, C. G., Swanson, D. A., Figlin, R. A., Belldegrun, A. S., & Pantuck, A. J. (2005). Prognostic value of histologic subtypes in renal cell carcinoma: A multicenter experience. Journal of Clinical Oncology, 23(12), 2763–2771.

[14] Marberger, MM, Chapple, CR. (2008). Renal cell carcinoma. Official Journal of the European Association of Urology, 4(1), 189–194

[15] Badmus, T. A., Salako, A. A., Arogundade, F. A., Sanusi, A. A., Adesunkanmi, A. R., Oyebamiji, E. O., Bakare, T. I., & Oseni, G. O. (2008). Malignant renal tumors in adults: A ten-year review in a Nigerian hospital. Saudi Journal of Kidney Diseases and Transplantation, 19(1), 120–126.

[16] Chen, S. H., Wu, Y. P., Li, X. D., Lin, T., Guo, Q. Y., Chen, Y. H., Huang, J. B., Wei, Y., Xue, X. Y., Zheng, Q. S., & Xu, N. (2017). R.E.N.A.L. nephrometry score: A preoperative risk factor predicting the fuhrman grade of clear-cell renal carcinoma. Journal of Cancer, 8, 3725–3732.

[17] Matos, A., Dall´Oglio, M., Colombo, Jr., J., Crippa, A., Juveniz, J., & Argolo, F. (2017). Predicting outcomes in partial nephrectomy: Is the renal score useful? International Brazilian Journal of Urology, 43(3), 422–431.

[18] Corradi, R., Vertosick, E., Nguyen, D., Vilaseca, A., Sjoberg, D., Benfante, N., Nogueira, L. N., Spaliviero, M., Touijer, K. A., Russo, P., & Coleman, J. A. (2017). Nephrometry scores and perioperative outcomes following robotic partial nephrectomy. International Brazilian Journal of Urology, 43(6), 1075–1083.

[19] Khan, I., Basu, S., Das, R., Dey, R., Khan, D., & Agarwal, V. (2019). RENAL nephrometry score: Predicting perioperative outcomes following open partial nephrectomy. Urology Annals, 11(2), 187.

[20] Wu, C., Chen, Y., Lu, K., Huang, C., Lin, H., & Lin, V. (2015). External validation of RENAL nephrometry score to access the perioperative parameter for laparoscopic partial nephrectomy in a single institution. Urological Science, 26(2), S42.