Kidney surgery, particularly partial nephrectomy (i.e., selective removal of the tumor while preserving the rest of the kidney), is often a complex challenge even for experienced surgeons. Every kidney tumor is different: it may be more or less deep, close to important vessels or the urinary tract, and these characteristics directly influence the difficulty of the operation and its results.
To address this complexity, various tools based on radiological images (CT or MRI) have been developed over the years, which help urologists to "measure" the complexity of the tumor before surgery. In other words, these tools allow us to estimate in advance how complex the operation will be and what results we can expect.
Researchers from the Urology Department at IRCCS Ospedale San Raffaele conducted the first prospective study directly comparing six of these assessment systems, applying them to 202 patients who underwent surgery for kidney cancer. The aim was to answer a very specific question: which tool is the most reliable for predicting the success of a partial nephrectomy? This is particularly relevant because, although international guidelines recommend the use of these systems, they do not indicate which one is best.
But what does "successful" surgery mean? In our study, we defined it in a very realistic way, considering several aspects that are important to the patient: preserving the kidney, avoiding significant complications, limiting the time during which the kidney is temporarily excluded from circulation, and achieving complete removal of the tumor. Only when all these objectives are achieved can the surgery be considered fully successful.
The results showed that all the tools analyzed are useful, but one in particular—called the SPARE score—proved to be the most accurate in predicting both the overall success of the procedure and the possibility of preserving the kidney. In addition, this system has the advantage of being simpler and more easily applicable in daily practice.
In the Urology Department at San Raffaele Hospital, we use the best tools available to plan each procedure in a personalized way, combining advanced technology, surgical experience, and scientific research. Studies like this allow us to offer patients increasingly safe, predictable, and tailored surgery, even before they enter the operating room.
Longoni M, Brembilla G, Rosiello G, Scilipoti P, Cosenza M, Imperiale G, Belladelli F, Re C, Musso G, Cei F, Salerno L, Folcia A, Ciccarone C, Briganti A, Karakiewicz P, Salonia A, Larcher A, Montorsi F, De Cobelli F, Capitanio U. Head-to-head comparison of nephrometry scores for partial nephrectomy: implications for clinical guidelines. Eur J Surg Oncol. 2025 Sep;51(9):110283. doi: 10.1016/j.ejso.2025.110283. Epub 2025 Jun 26. PMID: 40592281.
