{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T11:34:18Z","timestamp":1792755258899,"version":"4.5.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Tumor complexity scoring supports preoperative planning for robot-assisted partial nephrectomy (RAPN), but evidence in larger tumors is limited. We evaluated whether PADUA and RENAL nephrometry scores are associated with early perioperative outcomes in a stage-focused cohort of pathological pT1b or higher renal tumors treated with multiport RAPN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed a prospectively maintained single-center database of multiport RAPN cases (2011\u20132025). Patients with pathological pT1b\u2013pT2a disease were included. The primary endpoint was a 30-day composite adverse outcome: major complications (Clavien\u2013Dindo \u22653) and\/or perioperative transfusion. Secondary endpoints were any complication (Clavien 1\u20135), transfusion, warm ischemia time (WIT; continuous and &amp;gt;25\u2005min), operative time, length of stay, and trifecta achievement. Associations were tested using logistic regression (penalized models for sparse outcomes), linear regression, and AUC;\n                      <jats:italic>\u03b2<\/jats:italic>\n                      represents the adjusted change in the outcome per 1-point increase in score.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 109 patients were included (PADUA available in 108; RENAL in 83). Neither PADUA nor RENAL was independently associated with the composite adverse outcome, and discrimination was limited (PADUA AUC 0.583, 95% CI 0.411\u20130.733; RENAL AUC 0.563, 95% CI 0.347\u20130.775;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.738). Both scores were associated with intraoperative metrics. Each 1-point increase in PADUA correlated with longer WIT (\u03b2 1.13\u2005min; 95% CI 0.20\u20132.07;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019) and operative time (\u03b2 4.55\u2005min; 95% CI 0.20\u20138.90;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.043). Each 1-point increase in RENAL correlated with longer WIT (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      1.33\u2005min; 95% CI 0.25\u20132.40;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018) and operative time (\u03b2 5.01\u2005min; 95% CI 1.62\u20138.40;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). Trifecta achievement was not significantly associated with either score.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with pathological pT1b or higher renal tumors treated with multiport RAPN, PADUA and RENAL scores were not associated with a 30-day composite adverse outcome and had limited discrimination for major morbidity and\/or transfusion, but both correlated with WIT and operative time. Larger externally validated cohorts incorporating longitudinal renal function and broader patient-level risk factors are needed to refine preoperative risk assessment in larger renal tumors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1801634","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T13:14:19Z","timestamp":1777554859000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Association of PADUA and RENAL scores with early perioperative outcomes in large renal tumors managed with robot-assisted partial nephrectomy"],"prefix":"10.3389","volume":"13","author":[{"given":"Tunkut","family":"Doganca","sequence":"first","affiliation":[{"name":"Department of Urology, Acibadem Taksim Hospital","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boran","family":"Aksakal","sequence":"additional","affiliation":[{"name":"School of Medicine, Acibadem Mehmet Ali Aydinlar University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osman","family":"Acar","sequence":"additional","affiliation":[{"name":"School of Medicine, Acibadem Mehmet Ali Aydinlar University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ceyda","family":"Buyuker","sequence":"additional","affiliation":[{"name":"School of Medicine, Acibadem Mehmet Ali Aydinlar University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilter","family":"Tufek","sequence":"additional","affiliation":[{"name":"Department of Urology, School of Medicine, Acibadem Mehmet Ali Aydinlar University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Riza","family":"Kural","sequence":"additional","affiliation":[{"name":"Department of Urology, School of Medicine, Acibadem Mehmet Ali Aydinlar University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"435","DOI":"10.4111\/icu.20230121","article-title":"How far has robot-assisted partial nephrectomy reached?","volume":"64","author":"Lee","year":"2023","journal-title":"Investig Clin Urol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1111\/iju.13001","article-title":"Robot-assisted partial nephrectomy: superiority over laparoscopic partial nephrectomy","volume":"23","author":"Shiroki","year":"2016","journal-title":"Int J Urol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"113","DOI":"10.23736\/S0393-2249.19.03391-5","article-title":"Robot-assisted versus open partial nephrectomy: comparison of outcomes. 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