Derweesh IH et al. (2006) The predictive value of helical computed tomography for collecting-system entry during nephron-sparing surgery. BJU Int 98: 963–968

Minimally invasive and nephron-sparing surgery (NSS) is becoming more and more popular in the treatment of localised renal cell carcinoma, although total and radical nephrectomy still have their place. Accurate knowledge of the tumor position and other tumor characteristics is vital in deciding which type of surgery is right for each patient. For instance, surgeons might decide total nephrectomy is preferable if NSS might lead to injury to the renal collecting system. Derweesh et al. investigated, in a retrospective study, whether information from helical CT can predict collecting-system injury during NSS.

Three-phase renal helical CT scans were obtained for 344 patients (mean age 61 years, 232 males) before they underwent NSS. Collecting-system entry was recorded for 170 of these patients. Collecting-system entry was more common in patients with a central tumor location, calyceal involvement, and tumor size >4 cm (all P ≤0.005). Nearly three-quarters of the patients with a centrally located tumor experienced collecting-system entry during surgery.

The authors conclude that helical CT is a useful tool for the assessment of tumor characteristics, and might aid the surgeon in choosing the most appropriate type of surgery for individual patients.