[65] Use of the R.E.N.A.L nephrometry score in decision making for renal cell carcinoma (RCC) treatment

Objective: To assess the usefulness of the R.E.N.A.L nephrometry score in surgical decision making in patients with renal cell carcinoma (RCC). The R.E.N.A.L nephrometry score parameters are radius, exophytic/endophytic properties, nearness of the tumour to the collecting system or sinus, anterior or posterior location, and location relative to the polar lines. Classification of RCC according to nephrometry score: low complexity score 4–6, moderate complexity 7–9, and high complexity score 10–12 points. Methods: We looked retrospectively at the imaging of 70 cases of RCC against the operative procedure that was performed. Results: There were 20 cases with low complexity scores: seven (35%) underwent radical nephrectomy (RN) and 13 (65%) underwent partial nephrectomy (PN). There were 32 cases of moderate complexity: 24 (75%) underwent RN and eight (25%) underwent PN. There were 18 cases of high complexity and all of them (100%) underwent RN. Conclusion: Of the 20 (35%) cases with low complexity scores the T1a RCC tumours should have been offered PN. Of the 32 cases with moderate complexity scores, 24 (75%) patients with T1b RCC tumours should have been offered PN after discussion of an 8% risk of positive surgical margins. Nephron-sparing surgery should be offered to patients with low or moderate complexity and the R.E.N.A.L nephrometry score can used to aid this decision