MP54-12 DIABETES MELLITUS IS ASSOCIATED WITH AN INCREASED RISK OF CANCER-SPECIFIC MORTALITY AMONG PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA UNDERGOING NEPHRECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: Body mass index (BMI) is not independently associated with adverse perioperative outcomes following minimally invasive partial nephrectomy (MIPN). Several groups, however, have implicated that the distribution of fat (visceral vs. adipose) may serve as a better predictor for surgical outcomes. These data remain conflicting. We investigate the association of 1) perinephric fat thickness and 2) ratio of perinephric to subcutaneous fat thickness on outcomes following MIPN. METHODS: Clinical, radiographic, procedural, and pathologic data were collected for 220 consecutive patients undergoing MIPN by two surgeons via laparoscopic (n1⁄4109) or robotic (n1⁄4111) techniques. Perinephric (PF) and subcutaneous fat (SF) thickness was measured on preoperative axial imaging at the level of the renal vein and umbilicus, respectively. (Figure) The association between PF thickness and PF:SF ratio on surgical outcomes was determined by Spearman correlation and logistic regression. RESULTS: 111 men and 109 women with a median age of 55 years, BMI of 32, tumor size 2.6cm, and RENAL nephrometry score of 6 were included. On preoperative imaging, median PF thickness was 2.2 cm, SF thickness 3.1 cm, and PF:SF ratio of 0.63. Median operative duration was 212 minutes, ischemia duration 22 minutes, EBL 150 cc, and length of stay was 3 days. Seven patients had positive surgical margins, and 58 (26%) had postoperative complications including 10 with Clavien III or higher. There were statistically significant positive correlations between PF thickness (Spearman correlation coefficient 1⁄4 0.26, p 1⁄4 0.001) and PF:SF ratio (Spearman correlation coefficient 1⁄4 0.33, p < 0.0001) with OR duration. Additionally, an increasing PF:SF ratio was associated with a greater risk of perioperative complications (OR 1⁄4 1.82, 95% CI 1.1 3.0, p 1⁄4 0.02). No association was observed with respect to ischemia time, blood loss, length of stay, margin status, or postoperative renal function. CONCLUSIONS: PF thickness is associated with longer OR duration, and a greater PF:SF ratio correlated with increased OR duration and complications following MIPN. These easily measured indices of fat distribution are likely more accurate in predicting perioperative outcomes after MIPN than BMI alone. Source of Funding: None