Doctors often use specific scores to guess how hard a kidney tumor removal will be. This study looked at 109 patients who had robot-assisted partial nephrectomy between 2011 and 2025. The team used two common scoring systems called PADUA and RENAL to measure tumor complexity before surgery. They wanted to know if these scores could warn about major problems like serious complications or the need for blood transfusions within 30 days. The data came from a single hospital database. This means the results might not apply to other centers or larger groups of patients yet. The study was observational, so it shows connections but does not prove that the scores cause the outcomes. The researchers tested these links using regression models. They found that higher complexity scores were linked to longer surgery times. For every point increase in the PADUA score, surgery took about 4.5 minutes longer. For every point increase in the RENAL score, surgery took about 5 minutes longer. Similarly, higher scores were linked to longer times when the kidney was not getting blood flow. However, the scores did not predict major complications or transfusions. The ability of these scores to predict serious problems was limited. The study also noted that evidence for larger tumors is scarce. More research with bigger groups of patients is needed to confirm these findings and include more patient details.
Nephrometry Scores Show Limited Discrimination for Adverse Outcomes After RAPN in Larger Renal TumorsTumor complexity scores predict longer surgery time but not major complications in kidney cancer removal
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This retrospective cohort study analyzed 109 patients with pathological pT1b–pT2a renal tumors who underwent multiport robot-assisted partial nephrectomy (RAPN) at a single center from 2011 to 2025. The study assessed whether PADUA and RENAL nephrometry scores, per 1-point increase, were associated with a 30-day composite adverse outcome of major complications (Clavien–Dindo ≥3) and/or perioperative transfusion.
Neither PADUA nor RENAL was independently associated with the composite adverse outcome (combined discrimination test p = 0.738). Discrimination for this outcome was limited for both scores: PADUA AUC 0.583 (95% CI 0.411–0.733) and RENAL AUC 0.563 (95% CI 0.347–0.775). However, each 1-point increase in PADUA was associated with longer warm ischemia time (β 1.13 min; 95% CI 0.20–2.07; p = 0.019) and longer operative time (β 4.55 min; 95% CI 0.20–8.90; p = 0.043). Similarly, each 1-point increase in RENAL was associated with longer warm ischemia time (β 1.33 min; 95% CI 0.25–2.40; p = 0.018) and longer operative time (β 5.01 min; 95% CI 1.62–8.40; p = 0.005). Trifecta achievement was not significantly associated with either score.
Safety outcomes were limited to major complications and transfusion, with no other adverse events reported. The study is limited by its single-center design, small sample size, sparse outcomes requiring penalized models, and limited evidence in larger tumors. The observational nature precludes causal inference.
Clinically, tumor complexity scoring may support preoperative planning for RAPN, but these findings suggest limited ability to predict major morbidity or transfusion in patients with larger renal tumors. Larger, externally validated cohorts incorporating longitudinal renal function and broader risk factors are needed.
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