PD29-01 PREDICTING RENAL PARENCHYMAL LOSS FOLLOWING NEPHRON SPARING SURGERY

Abstract

You have accessJournal of UrologyKidney Cancer: Surgical Therapy I1 Apr 2015PD29-01 PREDICTING RENAL PARENCHYMAL LOSS FOLLOWING NEPHRON SPARING SURGERY Solomon Woldu, Alexa Meyer, Aaron Weinberg, Justin Matulay, Gregory Thoreson, Phillip Pierorazio, Mitchell Benson, G. Joel DeCastro, and James McKiernan Solomon WolduSolomon Woldu More articles by this author , Alexa MeyerAlexa Meyer More articles by this author , Aaron WeinbergAaron Weinberg More articles by this author , Justin MatulayJustin Matulay More articles by this author , Gregory ThoresonGregory Thoreson More articles by this author , Phillip PierorazioPhillip Pierorazio More articles by this author , Mitchell BensonMitchell Benson More articles by this author , G. Joel DeCastroG. Joel DeCastro More articles by this author , and James McKiernanJames McKiernan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1788AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Numerous studies indicate the importance of renal preservation in the surgical management of renal masses due to the correlation of functional renal parenchymal volume (FRPV) and renal function. We analyze the relationship between patient, operative, and tumor characteristics to determine which factors correlate with FRPV after nephron sparing surgery (NSS) using a 3-dimensional (3-D) volume assessment. METHODS Retrospective review of our institutional database from 1992-2014 of patients who underwent NSS for a localized renal mass with available contrast-enhanced preoperative and postoperative imaging (CT or MRI). Tumors were classified according to the R.E.N.A.L. nephrometry system. Using 3-D reconstruction software, preoperative and postoperative FRPV was calculated for the ipsilateral and contralateral kidney. RESULTS 158 patients were included in the study; mean age 58.7 years and mean follow-up of 40.1 months. The mean preoperative tumor volume was 34.0cc and mean tumor dimension was 3.4cm. The mean change in FRPV after NSS was -15.3% for the ipsilateral kidney and -6.8% for the total kidney volume. The mean R.E.N.A.L. nephrometry score was 6.2, with 60.1%, 34.2%, and 5.7% of tumors classified as low, medium, and high complexity, respectively. Increasing complexity was associated with increased FRPV loss (Table 1). On univariate analysis, ischemia time, tumor size, R.E.N.A.L. nephrometry score, complexity grouping, and the individual nephrometry components of tumor size, percent exophytic, depth, and whether tumor touches the renal artery or vein were all associated with larger FRPV loss. On multivariate analysis, only ischemia time, tumor size, and percent exophytic were independently associated with more FRPV loss (Table 2). CONCLUSIONS Using precise 3-D volumetric analysis, we find that ischemia time, tumor size, and the endophytic/exophytic properties of a localized renal mass are the most important determinants of FRPV loss. Examination of these predictors of volume loss may aid in prediction of functional outcomes following NSS. Table 1. Functional Renal Parenchymal Volume (FRPV) Loss by R.E.N.A.L. Nephrometry Complexity Grouping Low Medium High p-value Total Number 95 54 9 --- Mean % Change in Ipsilateral FRPV -11.53±13.91 -18.86±14.90 -33.93±16.59 <0.001 > 10% Loss 54.7% 70.4% 100.0% 0.010 > 20% Loss 23.2% 38.9% 88.9% <0.001 > 30% Loss 8.4% 20.4% 44.4% 0.005 > 40% Loss 3.2% 11.1% 33.3% 0.002 > 50% Loss 1.1% 3.7% 22.2% 0.002 Table 2. Multivariate Regression Analysis: Variables Influencing % Change in Ipsilateral Functional Renal Parenchymal Volume (FRPV) B 95% CI p-value CCI -0.075 -1.114, 0.964 0.887 Preoperative GFR -0.070 -.182, 0.043 0.222 Ischemia Time (minutes) -0.279 -.501, -0.057 0.014 Ischemia Type Cold reference Warm -3.165 -10.227, 3.898 0.377 EBL (cc) 0.005 -0.005, 0.014 0.325 Approach Open reference Lap -2.068 -9.506, 5.369 0.583 Robotic -0.768 -7.941, 6.406 0.833 Tumor Size (cm) -2.365 -3.845, -0.885 0.002 E-Score -6.771 -10.822, -2.719 0.001 N-Score 0.540 -2.346, 3.426 0.712 A-Score Anterior (a) reference Neither (x) -1.922 -8.660, 4.816 0.574 Posterior (p) -5.590 -10.921, -0.259 0.040 L-Score -1.245 -4.131, 1.640 0.395 H-Component -6.728 -15.059, 1.604 0.113 *CI = confidence interval, CCI = Charlson Comorbidity Index, GFR = glomerular filtration rate, unit in mL/min/1.73m2, EBL = estimated blood loss © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e648-e649 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Solomon Woldu More articles by this author Alexa Meyer More articles by this author Aaron Weinberg More articles by this author Justin Matulay More articles by this author Gregory Thoreson More articles by this author Phillip Pierorazio More articles by this author Mitchell Benson More articles by this author G. Joel DeCastro More articles by this author James McKiernan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...