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Background <p>Completely endophytic renal tumors (CERTs) pose significant challenges in surgical decision-making owing to their intricate anatomical locations and structures. Currently, clinical practice lacks a standardized classification system to guide surgical approaches for CERTs situated in diverse anatomical regions. This study proposes an innovative imaging-guided classification system designed to facilitate personalized surgical guidance. In addition, we evaluated the system’s effectiveness in improving surgical precision and clinical outcomes.</p> Patients and Methods <p>A retrospective analysis was conducted on 190 patients with CERT who underwent partial nephrectomy (PN) at the Second Hospital of Tianjin Medical University from 2018 to 2024. Utilizing the novel imaging-based CERT classification, optimal surgical strategies were identified for each subtype. The clinicopathologic characteristics, postoperative renal function recovery, and prognostic outcomes among patient subgroups were systematically assessed. Furthermore, independent predictors of Trifecta achievement in patients with CERT following PN were identified.</p> Results <p>The 190 CERT cases were classified into three categories on the basis of imaging criteria: Type I (<i>N</i> = 57), Type II (<i>N</i> = 107; subdivided into IIa: 70, and IIb: 37), and Type III (<i>N</i> = 26). Compared with Types I and II, patients classified as Type III demonstrated significantly higher P.A.D.U.A. and R.E.N.A.L. scores, longer operative times, increased warm ischemia times (WITs), and notably lower Trifecta achievement rates. Univariate and multivariate logistic regression analyses identified ASA score, tumor size, and the newly proposed CERT classification system as independent predictors of Trifecta achievement.</p> Conclusions <p>The imaging-guided CERT classification system effectively guides personalized surgical planning, enhances surgical precision, and promotes improved postoperative renal function recovery.</p> <p>Research registration unique identifying number (UIN): UNI:NCT06954571.</p>

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A Novel Imaging-Guided Classification System for Completely Endophytic Renal Tumors: Strategies for Optimal Partial Nephrectomy and Clinical Outcome Comparison

  • 期刊论文

  • 发表日期：

    2025年11月22日

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  • Keruo Wang,
  • Jianwei Zhang,
  • Wenzhe Zhou,
  • Yaru Liu,
  • Zhili Yao,
  • Jiahong Yao,
  • Yaofeng Liu,
  • Jiaming Zhang,
  • Kangkang Liu,
  • Gang Li

摘要

Background

Completely endophytic renal tumors (CERTs) pose significant challenges in surgical decision-making owing to their intricate anatomical locations and structures. Currently, clinical practice lacks a standardized classification system to guide surgical approaches for CERTs situated in diverse anatomical regions. This study proposes an innovative imaging-guided classification system designed to facilitate personalized surgical guidance. In addition, we evaluated the system’s effectiveness in improving surgical precision and clinical outcomes.

Patients and Methods

A retrospective analysis was conducted on 190 patients with CERT who underwent partial nephrectomy (PN) at the Second Hospital of Tianjin Medical University from 2018 to 2024. Utilizing the novel imaging-based CERT classification, optimal surgical strategies were identified for each subtype. The clinicopathologic characteristics, postoperative renal function recovery, and prognostic outcomes among patient subgroups were systematically assessed. Furthermore, independent predictors of Trifecta achievement in patients with CERT following PN were identified.

Results

The 190 CERT cases were classified into three categories on the basis of imaging criteria: Type I (N = 57), Type II (N = 107; subdivided into IIa: 70, and IIb: 37), and Type III (N = 26). Compared with Types I and II, patients classified as Type III demonstrated significantly higher P.A.D.U.A. and R.E.N.A.L. scores, longer operative times, increased warm ischemia times (WITs), and notably lower Trifecta achievement rates. Univariate and multivariate logistic regression analyses identified ASA score, tumor size, and the newly proposed CERT classification system as independent predictors of Trifecta achievement.

Conclusions

The imaging-guided CERT classification system effectively guides personalized surgical planning, enhances surgical precision, and promotes improved postoperative renal function recovery.

Research registration unique identifying number (UIN): UNI:NCT06954571.