DDD Score Outperforms RENAL and PADUA in Predicting Ischemia Time and Trifecta Outcomes in Laparoscopic Partial...

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Partial nephrectomy (PN) is standard for localized renal cell carcinoma (RCC).
• Nephrometry scores (RENAL, PADUA) aid surgical planning but can be complex.
• The DDD (Diameter, Depth, Distance) score offers a simpler alternative for assessing tumor complexity.

Purpose of the Study:

• To evaluate the efficacy of the DDD score in assessing surgical complexity for PN.
• To compare the predictive performance of the DDD score against RENAL and PADUA scores.
• To determine the DDD score's utility in predicting perioperative outcomes in RCC patients.

Main Methods:

• Retrospective analysis of 144 RCC patients undergoing PN (2018-2024).
• Tumor complexity assessed using DDD, RENAL, and PADUA scores.
• Comparison of predictive performance using ROC curves and AUC analysis for perioperative outcomes.

Main Results:

• The DDD score significantly correlated with ischemia time, operative time, and hospital stay.
• DDD score categories showed significant differences in ischemia time (P=.006), operative time (P=.001), and hospital stay (P=.001).
• DDD outperformed RENAL and PADUA in predicting ischemia time >25 minutes (AUC: 0.64) and trifecta outcomes (P=.038).

Conclusions:

• The DDD score is a simple, effective tool for assessing RCC surgical complexity.
• It offers superior predictive value for ischemia and operative time compared to RENAL and PADUA.
• The DDD score shows promise for enhancing perioperative planning in partial nephrectomy, warranting further prospective validation.