Analysis of Clinical Characteristics, Radiological Predictors, Pathological Features, and Perioperative Outcomes Associated with Perinephric Fat Adhesion Degree.

Junqiang Liu,Huafeng Zong,Hongwei Huang,Xuejian Wang,Jing Chen,Lina Wang,Xishuang Song,Zheng Zhu,Sony Nahayo,Yiheng Jiang,Dikuan Liu,Jianbo Wang,Xinqing Zhu,Qiwei Chen,Deyong Yang,Reza Izadpanah

doi:10.1155/2021/9095469

Abstract

Background To assess the clinical characteristics, radiological predictors, and pathological features of perinephric fat adhesion degree (PFAD) graded based on fixed criteria and to determine the impact of adherent perinephric fat (APF) on retroperitoneal laparoscopic partial nephrectomy (RLPN) outcomes. Methods 84 patients undergoing RLPN were included and graded into 4 groups based on PFAD. Univariate and multivariate analyses were performed for clinical characteristics and radiological predictors of PFAD. Perioperative data were compared between APF groups and non-APF groups. Masson staining determined collagen fibers. Immunohistochemistry detected CD45 immune cells and CD34 vessels. Results 20, 28, 18, and 18 patients were graded as normal perinephric fat (NPF), mild adherent perinephric fat (MiPF), moderate adherent perinephric fat (MoPF), and severe adherent perinephric fat (SPF), respectively. Multivariate analysis revealed that gender (p < 0.001), age (p = 0.003), and hypertension (p = 0.006) were significant clinical risk factors of PFAD, while radiological predictors included perinephric stranding (p = 0.001), posterior perinephric fat thickness (p = 0.009), and perinephric fat density (p = 0.02). APF was associated with drain output (p = 0.012) and accompanied by immune cells gathering in renal cortex near thickened renal capsule with many vessels. Conclusions Clinical characteristics and radiological predictors can evaluate PFAD and may assist to guide preoperative surgical option. Pathological features of APF reflect decapsulation and bleeding during kidney mobilization at RLPN.

Highlights

For T1 stage renal cell carcinoma, especially for T1a tumors, partial nephrectomy is recognized as the standard operation whenever technically feasible [1,2,3]
Patients’ Clinical and Radiographic Characteristics. e clinical and radiographic characteristics in our study are given in Table 1. e perinephric fat adhesion degree (PFAD) was graded as none, mild, moderate, and severe in 23.8%, 33.3%, 21.4%, and 21.4% of our patient cohort, respectively
57% of the patients were over 55 years. e majority of patients were male (61.9%) and had malignant tumors (61.9%). e proportion of patients with malignant tumors and hypertension increases with the PFAD, as well as the median perinephric fat area and perinephric fat thickness

Summary

Introduction

For T1 stage renal cell carcinoma, especially for T1a tumors, partial nephrectomy is recognized as the standard operation whenever technically feasible [1,2,3]. Dariane et al. To assess the clinical characteristics, radiological predictors, and pathological features of perinephric fat adhesion degree (PFAD) graded based on fixed criteria and to determine the impact of adherent perinephric fat (APF) on retroperitoneal laparoscopic partial nephrectomy (RLPN) outcomes. 84 patients undergoing RLPN were included and graded into 4 groups based on PFAD. Univariate and multivariate analyses were performed for clinical characteristics and radiological predictors of PFAD. Multivariate analysis revealed that gender (p < 0.001), age (p 0.003), and hypertension (p 0.006) were significant clinical risk factors of PFAD, while radiological predictors included perinephric stranding (p 0.001), posterior perinephric fat thickness (p 0.009), and perinephric fat density (p 0.02). Clinical characteristics and radiological predictors can evaluate PFAD and may assist to guide preoperative surgical option. Pathological features of APF reflect decapsulation and bleeding during kidney mobilization at RLPN

Methods

Results

Conclusion