Introduction

1. No. 073 Use of the novel technique of R.E.N.A.L. Nephrometry to assess surgical decision-making at an Australian tertiary referral centre P Satasivam, N Rajarubendran, PH Chia, A Munshey, S Sengupta, D Bolton The Austin Hospital, Heidelberg VIC Results RN was performed for significantly larger lesions (68 ± 9mm vs 29 ± 2mm, p < 0.05) of predominantly moderate- and high-complexity (12% low, 56% moderate, 32% high). Conversely, NSS was performed for predominantly low-complexity lesions. The use of NSS increased from 28.6% of cases in 2005 to 60.0% of cases in 2009 (p = 0.01 for trend). This mirrored the increase in the proportion of operations performed for low complexity lesions (22.2% low-complexity in 2005 to 70.6% in 2009, p < 0.01). 54% of NSS cases were performed laparoscopically. The percentage of cases undertaken laparoscopically increased from none in 2005 to 82% in 2009 ( p < 0.001). • Introduction • Radical nephrectomy (RN) may lead to the development of chronic kidney disease and its complications. • Consequently, elective nephron-sparing surgery (NSS) for suitable renal lesions has become widely advocated. • The R.E.N.A.L. nephrometry score is an objective measure of factors important in determining suitability for (NSS), such as size, exophytic nature, proximity to collecting system and polar location. • Aims • To examine local trends in the use of NSS by applying R.E.N.A.L. nephrometry to lesions treated by RN or NSS. • Methods • Retrospective review of renal masses treated by surgery from January 2005 to December 2009, including 79 RN and 70 NSS. • CT images available for analysis in 50 patients within each group. • Lesions were scored on the basis of their complexity using the R.E.N.A.L. nephrometry scoring system developed by Kutikov and Uzzo. • Comparisons were made using Chi-square or Fisher's exact tests, with statistical significance ascribed to p<0.05. Trends were analysed using linear regression. • Discussion • The choice of surgical approach appeared to depend upon lesion complexity. • The increase in use of NSS may reflect either an increased detection or referral of suitable lesions, or a move away from surveillance protocols and non-surgical treatments for SRMs. • Our practice represents a metropolitan tertiary referral centre, and may not reflect current practice in regional or private centres throughout Australia. • Conclusions • The use of NSS at our institution increased over time and mirrored the incidence of low-complexity lesions. • Anatomical features of RCC may provide a predictive insight into tumour biology, and aid preoperative decision-making. References Kutikov A , Uzzo RG . The R.E.N.A.L. Nephrometry Score: a comprehensive standardized system for quantitating renal tumor size, location and depth . J Urol 2009 ; 182 : 844 – 53. Weight CJ et al . Nephrectomy Induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patientswith localized cT1b renal masses . J Urol 2010 ; 183 : 1317 – 23 Poster presentation sponsor