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

We retrospectively reviewed the preoperative radiologic findings and operational videos of a group of patients who were undergoing laparoscopic nephron-sparing surgery (NSS), to determine whether we should decide the operational approach (laparoscopic vs open or radical nephrectomy) on the basis of only the preoperative aspects and dimensions used for an anatomic (PADUA) classification.

In total, 41 laparoscopic NSS operations were performed during a 34-month period for suspicious solid renal lesions. Clinicopathologic variables, PADUA scores, operative parameters, and renal functional outcomes were prospectively recorded and analyzed. Meanwhile, a similar classification (intraoperative aspects and dimensions used for an anatomic [IADUA] classification) was used to compare the preoperative imaging modality findings with intraoperative findings.

There was a 73.2% difference between PADUA and IADUA scores. Sixteen (39%) patients had PADUA scores >IADUA scores, 14 (34%) had PADUA scores

Reproducible standardized classification systems are necessary for renal masses. Intraoperative findings for renal masses, however, may differ from the preoperative radiologic evaluation. Thus, the decision for the type of surgical approach should not be based solely on preoperative assessment, such as the PADUA score.