MP41-10 RENAL TUMOR ENUCLEATION MAXIMALLY PRESERVES RENAL PARENCHYMAL VOLUME COMPARED TO STANDARD PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I1 Apr 2016MP41-10 RENAL TUMOR ENUCLEATION MAXIMALLY PRESERVES RENAL PARENCHYMAL VOLUME COMPARED TO STANDARD PARTIAL NEPHRECTOMY Robert H. Blackwell, Belinda Li, Zachary Kozel, Zhiling Zhang, Juping Zhao, Sarah Capodice, Gregory Barton, Arpeet Shah, Jessica Wetterlin, Marcus L. Quek, Steven C. Campbell, and Gopal N. Gupta Robert H. BlackwellRobert H. Blackwell More articles by this author , Belinda LiBelinda Li More articles by this author , Zachary KozelZachary Kozel More articles by this author , Zhiling ZhangZhiling Zhang More articles by this author , Juping ZhaoJuping Zhao More articles by this author , Sarah CapodiceSarah Capodice More articles by this author , Gregory BartonGregory Barton More articles by this author , Arpeet ShahArpeet Shah More articles by this author , Jessica WetterlinJessica Wetterlin More articles by this author , Marcus L. QuekMarcus L. Quek More articles by this author , Steven C. CampbellSteven C. Campbell More articles by this author , and Gopal N. GuptaGopal N. Gupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.177AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal tumor enucleation is a technique that may facilitate maximal parenchymal preservation, but this has not been rigorously studied. We assess the precision of excision and reconstruction of tumor enucleation compared to standard partial nephrectomy. METHODS Robotic partial nephrectomy patients were included who had appropriate pre- and post-operative studies for analysis of parenchymal mass preservation specific to the operated kidney. CT or MR imaging and eGFR were required to be < 2mo prior to and 4-12 months after surgery. We report parenchymal mass preservation and surgical precision for each technique, with precision defined as the actual postoperative parenchymal volume/predicted parenchymal volume, presuming loss of a 5mm rim of normal parenchyma associated with tumor excision and reconstruction. RESULTS Analysis of 110 patients included 57 tumor enucleation and 53 standard partial nephrectomy. Median age, BMI, and tumor size were comparable, but tumor enucleation had more high complexity tumors by RENAL score (40.4% vs 18.9%, p=0.047). Percent parenchymal mass preserved in the operated kidney with tumor enucleation was 96% (IQR=89.6-100.0%) vs. 89% (IQR=83.3-96.3%) for standard partial nephrectomy (p=0.003). Precision of excision and reconstruction was 101% (IQR=95.5-105.1%) for tumor enucleation compared with 94% (IQR=88.3-100.0%) for standard partial nephrectomy (p<0.001). On multivariable analysis, only tumor enucleation correlated with improved surgical precision (coefficient 6.7, 95% CI 1.6 - 11.8, p=0.01). Functional preservation within the operated kidney also appeared to favor tumor enucleation although the differences were marginal (96% vs. 93%), and statistical significance was not observed (p=0.2). CONCLUSIONS Tumor enucleation maximally spares normal renal parenchyma compared to standard partial nephrectomy, and provides better surgical precision. Prospective study of tumor enucleation will be required to appropriately select patients for this technique. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e563-e564 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Robert H. Blackwell More articles by this author Belinda Li More articles by this author Zachary Kozel More articles by this author Zhiling Zhang More articles by this author Juping Zhao More articles by this author Sarah Capodice More articles by this author Gregory Barton More articles by this author Arpeet Shah More articles by this author Jessica Wetterlin More articles by this author Marcus L. Quek More articles by this author Steven C. Campbell More articles by this author Gopal N. Gupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...