LAUSR

Objective To assess the usefulness of the R.E.N.A.L nephrometry score in surgical decision making in patients with renal cell carcinoma (RCC). The R.E.N.A.L nephrometry score parameters are radius, exophytic/endophytic properties, nearness of the tumour to the collecting system or sinus, anterior or posterior location, and location relative to the polar lines. Classification of RCC according to nephrometry score: low complexity score 4–6, moderate complexity 7–9, and high complexity score 10–12 points. Methods We looked retrospectively at the imaging of 70 cases of RCC against the operative procedure that was performed. Results There were 20 cases with low complexity scores: seven (35%) underwent radical nephrectomy (RN) and 13 (65%) underwent partial nephrectomy (PN). There were 32 cases of moderate complexity: 24 (75%) underwent RN and eight (25%) underwent PN. There were 18 cases of high complexity and all of them (100%) underwent RN. Conclusion Of the 20 (35%) cases with low complexity scores the T1a RCC tumours should have been offered PN. Of the 32 cases with moderate complexity scores, 24 (75%) patients with T1b RCC tumours should have been offered PN after discussion of an 8% risk of positive surgical margins. Nephron-sparing surgery should be offered to patients with low or moderate complexity and the R.E.N.A.L nephrometry score can used to aid this decision.