Preoperative and intraoperative observations may differ during laparoscopic nephron-sparing surgery

Area of Science:

• Urology
• Surgical Oncology
• Radiology

Background:

• Nephron-sparing surgery (NSS) is a standard treatment for renal masses.
• Accurate preoperative assessment is crucial for planning NSS and predicting outcomes.
• The preoperative aspects and dimensions used for an anatomic (PADUA) classification is a tool used to assess renal masses.

Purpose of the Study:

• To evaluate the reliability of the preoperative aspects and dimensions used for an anatomic (PADUA) classification in guiding surgical approach decisions for laparoscopic nephron-sparing surgery (NSS).
• To compare preoperative radiologic findings with intraoperative findings using a similar classification system (intraoperative aspects and dimensions used for an anatomic [IADUA] classification).

Main Methods:

• Retrospective review of preoperative radiologic findings and operative videos from 41 patients undergoing laparoscopic NSS.
• Prospective recording and analysis of clinicopathologic variables, PADUA scores, operative parameters, and renal functional outcomes.
• Comparison of preoperative PADUA scores with intraoperative IADUA scores.

Main Results:

• Significant discrepancies (73.2%) were observed between preoperative PADUA scores and intraoperative IADUA scores.
• PADUA and IADUA scores did not correlate with operative time (OT), estimated blood loss (EBL), or perioperative complications.
• Higher PADUA scores did not predict increased perioperative complications.

Conclusions:

• Intraoperative findings for renal masses can differ substantially from preoperative radiologic evaluations.
• Standardized classification systems for renal masses are necessary but must account for potential intraoperative variations.
• Surgical approach decisions for NSS should not be based exclusively on preoperative assessments like the PADUA score.