Category: Laparoscopic/ Robotic: Other

MP16-19 - Comparing the Value of DAP Score and RENAL Score for Long-Term Trifecta Outcomes in Robot-assisted Partial Nephrectomy for Renal Cell Carcinoma- A Single Surgeon Experience

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective : Few studies reported the value of DAP (diameter-axial-polar) score in robot-assisted partial nephrectomy (RaPN) for renal cell carcinoma in Taiwanese population. This study aimed at demonstrating that DAP score as an effective tool, which is not inferior to RENAL score for predicting long-term surgical, oncological and functional outcomes of RaPN for kidney cancer. 


Methods : We retrospectively collected clinical data of 108 patients with pathologically confirmed RCC, receiving RaPN by single surgeon during the period, 2012-2017. The patients were stratified as low, intermediate, and high complexity according to the RENAL and DAP scoring system. We analyzed the warm ischemia time (WIT), cancer-specific survival, radiographic progression-free survival, positive rate of surgical margin, renal function (estimated glomerular filtration rate) of pre-operative period, post-operative 1st/6th month, and post-operative complication. This study is registered with the National Taiwan University Hospital Research Ethics Committee (number 201305059RINC).


Results : The median follow-up was 36 months. The 3-year cancer specific survival rate in all patients was 98.4%. The 3-year radiographic progression-free survival was 95.2%. There were 4 patients (3.6%) having positive surgical margin. The largest decrease of renal function from pre- to post-operative 6th month was noted in the intermediate RENAL score group. In our study, the predictive value of long-term outcomes of DAP score were not inferior to RENAL score, including WIT in 20 minutes (AUC of DAP vs RENAL=0.76 vs 0.68), WIT in 25 minutes (AUC of DAP vs RENAL=0.70 vs 0.71), positive margin (AUC of DAP vs RENAL=0.61 vs 0.34), 3-year radiographic local recurrence (AUC of DAP vs RENAL=0.92 vs 0.86), complication (AUC of DAP vs RENAL=0.56 vs 0.53), but failed to change of CKD status (AUC of DAP vs RENAL=0.41 vs 0.40). Our study also demonstrated that age may be an independent factor for progression to CKD after RaPN (Odds ratio=1.054, 95% CI=1.008-1.102, p=0.022). Complications occurred in 22 patients (20.4%), and the most common post-operative complications were bleeding (12.2%), followed by post-operative fever (0.5%) and urinary leakage (0.3%).


Conclusions : DAP score is an effective tool for predicting peri-operative outcomes of RaPN, especially in 3-year local recurrence, positive margin and WIT (warm ischemia time) less than 25 minutes.

Fan-Ching Hung

MD
Department of Urology, National Taiwan University Hospital
Taipei, Taipei, Taiwan (Republic of China)

Chi-Chih Lien

MD
Department of Urology, National Taiwan University Hospital
Taipei, Taipei, Taiwan (Republic of China)

Chao-Yuan Huang

MD
Department of Urology, National Taiwan University Hospital
Taipei, Taipei, Taiwan (Republic of China)

Yeong-Shiao Pu

MD
Department of Urology, National Taiwan University Hospital
Taipei, Taipei, Taiwan (Republic of China)

Chih-Hung Chiang