一家澳大利亚三级医疗中心应用保留肾单位手术(NSS)的趋势：关于采用R.E.N.A.L.肾脏测量评分系统指导手术决策制定的分析

Objective:

• To examine recent trends in the use of nephron-sparing surgery (NSS) at our centre. Specifically, we sought to examine the process of surgical decision-making by applying the R.E.N.A.L. nephrometry scoring system to assess the complexity of lesions for which surgery was undertaken.

Patients and Methods:

• We performed a retrospective review of renal masses treated by surgery from January 2005 to December 2009, including 79 RN and 70 NSS.

• CT images were available for analysis in 50 patients within each group.

• Lesions were scored on the basis of their complexity using the R.E.N.A.L. nephrometry scoring system developed by Kutikov and Uzzo.

Results:

• There was no difference in age between patients undergoing RN and NSS (median age 61 vs 60years).

• RN was performed for significantly larger lesions (mean [sd] 68 [9] vs 29 [2] mm, P<0.05) of predominantly moderate and high complexity (12% low, 56% moderate, 32% high).

• NSS was primarily used for low-complexity lesions, but included four (8%) moderate-complexity lesions in the final 2years of the study.

• The use of NSS increased from 28.6% of cases in 2005 to 60.0% of cases in 2009, which mirrored the increase in the proportion of operations performed for low-complexity lesions (22.2% low-complexity in 2005 to 70.6% in 2009, P<0.01 for trend).

Conclusions:

• The increasing use of NSS at our institution mirrored the increasing treatment of low-complexity renal lesions.

• This may reflect an increased detection and referral of such lesions, or a shift towards treatment of lesions that in the past would have been under surveillance.

• Practice at our centre reflects a shifting paradigm towards preferential use of NSS for the treatment of suitable renal masses.