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A three-dimensional renal tumor anatomy and intrarenal relationship nephrometry (ADDD) for robot-assisted partial nephrectomy

3D-CT based nephrometry for RAPN

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Abstract

Objective

To develop a 3D scoring system of tumor anatomy and intrarenal relationship for assessing surgical complexity and outcomes of robot-assisted partial nephrectomy (RAPN).

Methods

We prospectively enrolled patients with a renal tumor who had a 3D model and underwent RAPN between Mar 2019 and Mar 2022. The ADDD nephrometry consisted of the contact surface area between tumor and parenchyma (A), the depth of tumor invasion into the renal parenchyma (D1), the distance from tumor to the main intrarenal artery (D2), and to the collecting system (D3). The primary outcomes included perioperative complication rate and trifecta outcome (WIT ≤ 25 min, negative surgical margins, and no major complications).

Results

We enrolled a total of 301 patients. The mean tumor size was 2.93 ± 1.44 cm. There were 104 (34.6%) patients, 119 (39.5%) patients, and 78 (25.9%) patients in the low-, intermediate-, and high-risk groups, respectively. Each point increase in the ADDD score increased the risk of complications [hazard ratio (HR) 1.501]. A lower grade indicated a lower risk of failed trifecta (HR low group 15.103, intermediate group 9.258) and renal function damage (HR low risk 8.320, intermediate risk 3.165) compared to the high-risk group. The AUC of ADDD score and grade were 0.738 and 0.645 for predicting major complications, 0.766 and 0.714 for predicting trifecta outcome, and 0.746 and 0.730 for predicting postoperative renal function reservation.

Conclusion

The 3D-ADDD scoring system shows the tumor anatomy and its intraparenchymal relationships and has better efficacy in predicting surgical outcomes of RAPN.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

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Acknowledgements

The authors are grateful for the technical support provided by Jiaxin Xie, Xiao Zhang, Yue Wu, and Qiong Wu.

Funding

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Author information

Author notes

  1. Xinfei Li, Dapeng Wu and Xuepei Zhang have contributed equally to this paper.

Authors and Affiliations

  1. Department of Urology, Peking University First Hospital, National Urological Cancer Center, Institute of Urology, Peking University, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China

    Xinfei Li, Xiang Wang, Yangyang Xu, Shubo Fan, Zhihua Li, Kunlin Yang, Xiaoteng Yu, Zhongyuan Zhang, Lin Cai, Zheng Zhang, Cheng Shen, Liqun Zhou & Xuesong Li

  2. Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, China

    Dapeng Wu

  3. Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China

    Xuepei Zhang & Jin Tao

  4. Department of Urology, The Second Affiliated Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Hexi District, Tianjin, 300211, China

    Hailong Hu

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  1. Xinfei Li
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Contributions

Conception and design: XS L, HL Hu, and LQ Zhou. Surgery: DPW, XPZ, LC, ZZ, CS, JT, ZYZ, HLH, XSL, and LQZ. Data acquisition: DPW, XPZ, YYX, ZHL, KLY, and XTY. Data analysis and interpretation: XFL and XW. Drafting the manuscript: XFL. Critical revision of the manuscript for scientific and factual content: all authors. Supervision: SBF, ZHL, and LQZ. Ethics: SBF.

Corresponding authors

Correspondence to Hailong Hu, Liqun Zhou or Xuesong Li.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 23 kb)

Supplementary fig 1. The prospective study flowchart (TIF 4526 kb)

Supplementary fig 2. Three-dimensional model rendering process (JPG 856 kb)

345_2023_4448_MOESM4_ESM.jpg

Supplementary fig 3. Preoperative CTU, three-dimensional (3D) imaging, and intraoperative finding of a renal sinus tumor. A. axial plane, B. coronal plane, C. sagittal plane, D. 3D imaging, E. posterior view of 3D imaging in the 45° left recumbent position, F. simulation of tumor resection, G. intraoperative blood vessels and tumor exposure, H. 3D virtual model intraoperative navigation, I. defect after tumor resection (JPG 1636 kb)

345_2023_4448_MOESM5_ESM.tif

Supplementary fig 4. Heatmap of the correlation between three-dimensional parameters and perioperative results (TIF 8839 kb)

345_2023_4448_MOESM6_ESM.tif

Supplementary fig 5. Three-dimensional ADDD scoring system: intermediate risk (score = 9). A, B. contact surface area = 15.16 cm2 (score 2), C. depth =1.13 cm (score 1), D. distance from the tumor to the main intrarenal artery = 3.6 mm (score 3), E. Distance from the tumor to the collecting system = 0 mm (score 3) (TIF 2190 kb)

345_2023_4448_MOESM7_ESM.tif

Supplementary fig 6. Three-dimensional ADDD scoring system: high risk (score=11). A. contact surface area = 21.69 cm2 (score 3), B. depth =2.08 cm (score 2), C. distance from the tumor to the main intrarenal artery = 0 mm (score 3), D. distance from the tumor to the collecting system = 0 mm (score 3) (TIF 1422 kb)

345_2023_4448_MOESM8_ESM.tif

Supplementary fig 7. Three-dimensional ADDD scoring system: high risk (score=11)，A. contact surface area = 43.03 cm2 (score 3), B. depth = 2.84 cm (score 2), C. distance from the tumor to the main intrarenal artery = 0 mm (score 3), D, E. distance from the tumor to the collecting system = 0 mm (score 3) (TIF 2613 kb)

345_2023_4448_MOESM9_ESM.tif

Supplementary fig 8. Receiver-operating characteristic curve analysis of various scoring systems in predicting complication, trifecta outcome, and renal function reservation of RAPN. A. score-complication, B. score-trifecta outcome, C. score-renal function reservation, D. grade-complication, E. grade-trifecta outcome, F. grade-renal function reservation (TIF 6114 kb)

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Li, X., Wu, D., Zhang, X. et al. A three-dimensional renal tumor anatomy and intrarenal relationship nephrometry (ADDD) for robot-assisted partial nephrectomy. World J Urol 41, 1847–1853 (2023). https://doi.org/10.1007/s00345-023-04448-2

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  • DOI: https://doi.org/10.1007/s00345-023-04448-2

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