Mayo Adhesive Probability Score Research Articles

A Review of the Paradigmatic Role of Adipose Tissue in Renal Cancer: Fat Measurement and Tumor Behavior Features.

(1) Background: Renal-cell carcinoma (RCC) incidence has been steadily rising, with obesity identified as a potential risk factor. However, the relationship between obesity and RCC prognosis remains unclear. This systematic review aims to investigate the impact of different adipose tissue measurements on RCC behavior and prognosis. (2) Methods: A search of MEDLINE databases identified 20 eligible studies focusing on various fat measurements, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), perirenal adipose tissue (PRAT), and the Mayo adhesive probability (MAP) score. (3) Results: The review revealed conflicting findings regarding the association between adipose tissue measurements and RCC outcomes. While some studies suggested a protective role of certain fat deposits, particularly VAT, against disease progression and mortality, others reported contradictory results across different adipose metrics and RCC subtypes. (4) Conclusions: Methodological variations and limitations, such as retrospective designs and sample size constraints, pose challenges to standardization and generalizability. Further research is needed to understand these associations better and establish standardized approaches for adiposity assessment in RCC patients, which could inform clinical practice and therapeutic decision-making.

Predictive Value of the Mayo Adhesive Probability (MAP) Score in Laparoscopic Partial Nephrectomies: A Systematic Review from the EAU Section of Uro-Technology (ESUT).

The Mayo Adhesive Probability (MAP) score is a radiographic scoring system that predicts the presence of adherent perinephric fat (APF) during partial nephrectomies (PNs). The purpose of this systematic review is to summarize the current literature on the application of the MAP score for predicting intraoperative difficulties related to APF and complications in laparoscopic PNs. Three databases, PubMed, Scopus and Cochrane, were screened, from inception to 29 October 2023, taking into consideration the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. All the inclusion criteria were met by eight studies. The total operative time was around two hours in most studies, while the warm ischemia time was <30 min in all studies and <20 min in four studies. Positive surgical margins, conversion and transfusion rates ranged from 0% to 6.3%, from 0% to 5.0% and from 0.7% to 7.5%, respectively. Finally, the majority of the complications were classified as Grade I-II, according to the Clavien-Dindo Classification System. The MAP score is a useful tool for predicting not only the presence of APF during laparoscopic PNs but also various intraoperative and postoperative characteristics. It was found to be significantly associated with an increased operative time, estimated blood loss and intraoperative and postoperative complication rates.

The construction of a nomogram to predict the prognosis and recurrence risks of UPJO.

This study was conducted to explore the risk factors for the prognosis and recurrence of ureteropelvic junction obstruction (UPJO). The correlation of these variables with the prognosis and recurrence risks was analyzed by binary and multivariate logistic regression. Besides, a nomogram was constructed based on the multivariate logistic regression calculation. After the model was verified by the C-statistic, the ROC curve was plotted to evaluate the sensitivity of the model. Finally, the decision curve analysis (DCA) was conducted to estimate the clinical benefits and losses of intervention measures under a series of risk thresholds. Preoperative automated peritoneal dialysis (APD), preoperative urinary tract infection (UTI), preoperative renal parenchymal thickness (RPT), Mayo adhesive probability (MAP) score, and surgeon proficiency were the high-risk factors for the prognosis and recurrence of UPJO. In addition, a nomogram was constructed based on the above 5 variables. The area under the curve (AUC) was 0.8831 after self cross-validation, which validated that the specificity of the model was favorable. The column chart constructed by five factors has good predictive ability for the prognosis and recurrence of UPJO, which may provide more reasonable guidance for the clinical diagnosis and treatment of this disease.

Factors affecting the use of a three-dimensional model during robot-assisted partial nephrectomy.

This study aimed to identify cases that require a three-dimensional-printed kidney model in robot-assisted partial nephrectomy. We enrolled 93 patients undergoing robot-assisted partial nephrectomy for renal tumors at a single institution between November 2018 and May 2021. The endpoints were how often and how long the surgeon consulted the three-dimensional-printed model, determined using intraoperative video. Multivariate analyses of the endpoints were adjusted by preoperative patient and kidney characteristics, including renal vascular complexity that was defined as the number of vascular branches penetrating the surface tangential to the ventral side of the kidney. Of the 93 cases, the median frequency and duration of intraoperative three-dimensional-printed model consultation were four times and 39 s, respectively. The multivariate linear regression analyses showed that the frequency of intraoperative three-dimensional-printed model consultation by the surgeon was significantly related to the complexity of the arterial structure (≥4 branches), presence of hilar tumor, and high Mayo Adhesive Probability score; the regression coefficients were 1.81, 2.79, and 1.34, respectively. All p-values were ≤.03. The duration of the three-dimensional-printed model consultation was significantly related to the complexity of the arterial structure (≥4 branches) and the presence of hilar tumor; the regression coefficients were 21.6, and 29.0 s, respectively. All p-values were <.01. During robot-assisted partial nephrectomy, a three-dimensional-printed model would be helpful in cases with a complex arterial structure or hilar tumor.

Mayo Adhesive Probability score to predict renal function following partial nephrectomy.

379 Background: Mayo Adhesive Probability (MAP) score, which measures adherent perinephric fat in renal cell carcinoma (RCC), is associated with surgical complexity and cancer progression in patients undergoing partial nephrectomy (PN). PN carries perioperative risk but preserves renal function versus radical nephrectomy (RN). We analyzed whether MAP score can predict long-term postoperative renal function in localized RCC patients who underwent PN. Methods: We reviewed our nephrectomy database to identify pT1-T3a RCC patients who underwent PN. Patients with metastatic disease, IVC thrombus, multiple masses, and prior nephrectomy were excluded. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI 2021 formula and patients with values &lt;15mL/min/1.73m2 were excluded. We calculated MAP scores from preoperative cross-sectional imaging and dichotomized patients into low (1-3) versus high (4-5) cohorts. Continuous and categorical outcomes were compared using ANOVA and chi-square tests. A hierarchical generalized linear mixed effect model was used to evaluate predictors of long-term, postoperative eGFR following PN. Results: 314 patients were identified and 97 (30.9%) were classified with a high MAP score. These patients were older (64.5 vs. 58.3 years, p&lt;0.001), more often male (85.6% vs. 52.5%, p&lt;0.001), and white (79.4% vs. 67.7%, p=0.016). MAP score was associated with obesity (59.8% vs. 42.9%, p=0.006), diabetes (36.1% vs. 22.6%, p=0.013), hypertension (82.5% vs. 63.1%, p&lt;0.001), and severe CCI (5+; 35.1% vs. 23.5%, p&lt;0.001). No difference was observed in the rate of current or former smokers. Final tumor size was greater among patients with high MAP (4.1 vs. 3.4cm, p&lt;0.001) but no difference was noted in pT stage. Rate of acute renal failure postoperatively (dialysis or eGFR &lt;15 within 30 days) was similar between the two cohorts (1% vs. 1.4%, p=0.797). The tablepresents the model used to evaluate postoperative eGFR predictors. Conclusions: High MAP score predicts a greater eGFR decline following PN for localized RCC. Considering the risks of PN, MAP scoring may indicate surgical complexity and inform shared decision-making when considering nephron-sparing surgery for RCC. [Table: see text]

Is the Mayo Adhesive Probability Score Predictive in Patients Undergoing Percutaneous Nephrolithotomy?

Introduction: Mayo Adhesive Probability (MAP) score was developed as a means to predict the presence of adherent perinephric fat. Our aim was to determine the predictive value of the MAP score on surgical outcomes in patients undergoing standard adult percutaneous nephrolithotomy (PCNL). Materials and Methods: We retrospectively analyzed the data from 130 renal units that underwent PCNL between January 2022 and 2023. MAP scores 0-2 were classified as low, whereas MAP scores 3-5 were classified as high. The impact of the MAP score on perioperative and postoperative outcomes was studied. All statistical analyses were performed using SPSS 24.0 for Windows. Results: The median age of the patients at the time of surgery was 48 (21) years, with a female-to-male ratio of 1:1.82. The median MAP score was 2 (2), with 43.8% of patients falling into the high MAP score group. Advanced age, hypertension history, low estimated glomerular filtration rate (eGFR) levels, and low renal parenchymal thickness were significantly higher in the high MAP score group (P = .010, P = .004, P = .001, and P = .005, respectively). Female patients had a significantly higher MAP score of 0 (P = .021). Operation time, postoperative hematocrit decrease, blood transfusion rate, postoperative fever rate, hospitalization, and stone-free rates were comparable between the low and high MAP score groups (P = .535, P = .209, P = .313, P = .289, P = .281, and P = .264, respectively). Gender and eGFR levels were shown to be significant predictors of a MAP ≥3 (P = .004 and P = .003, respectively). Conclusion: The present study showed that the MAP score groups had similar perioperative and postoperative results. Low eGFR levels and the male gender were associated with MAP score ≥3. To determine the predictive MAP score value for PCNL outcomes, more prospective studies are needed.

Can the Mayo Adhesive Probability Score Predict Perioperative Outcomes in Laparoscopic Total and Partial Adrenalectomy?

Objective: This study aimed to determine whether the Mayo adhesive probability (MAP) score could predict perioperative outcomes in transperitoneal laparoscopic total adrenalectomy (LTA) and laparoscopic partial adrenalectomy (LPA). Materials and Methods: The clinical data of 139 patients who underwent transperitoneal LTA (n = 116) or LPA (n = 23) between March 2013 and September 2022 were retrospectively analyzed. According to the images obtained from preoperative contrast-enhanced computed tomography or magnetic resonance imaging, the patients were divided into two groups: the low MAP score group (0-1 points) and the high MAP score group (2-5 points). General clinical features and perioperative outcomes were compared between the groups. Results: In patients with a high MAP score, the mean body mass index (BMI) (p: 0.005), tumor size (p: 0.005), operative time (p: 0.002), estimated blood loss (EBL) (p: 0.001), and complication rate (p: 0.013) were significantly higher compared with those with a low MAP score. The comparison of the patients between the LTA and LPA subgroups revealed that operative time and EBL were significantly higher in both subgroups among the patients with a high MAP score. Moreover, the complication rate in the LTA subgroup was significantly higher in the high MAP score group compared with the other group. The Multivariate analyses revealed that a high MAP score was a risk factor for prolonged operative time (Odds Ratio [OR]: 3.081, 95% Confidence Interval [CI]: 1.284-7.398, p: 0.012), increased EBL (OR: 2.495, 95% CI: 1.114-5.588, p: 0.026), and complications (OR: 6.085, 95% CI: 1.532-24.171, p: 0.01) Conclusions: Patients with a high MAP score had a prolonged operative time, increased EBL, and a higher complication rate compared with those with a low MAP score. In addition, we found that a high MAP score was an independent risk factor for perioperative parameters and complications in patients who underwent LTA and LPA.

The Mayo adhesive probability score predicts postoperative fever and intraoperative hemorrhage in mini-percutaneous nephrolithotomy.

Contemporary predictive tools for miniaturized percutaneous nephrolithotomy (mPCNL) mainly focus on stone clearance but not perioperative complications, especially infection and hemorrhage. This study aimed to evaluate whether the Mayo adhesive probability (MAP) score, an index of the perinephric fat characteristics, can predict postoperative fever and intraoperative hemorrhage in mPCNL. This is a retrospective study recruiting 159 mPCNL patients from July 2018 to January 2022. MAP scores were recorded using preoperative computed tomography. Postoperative complications included postoperative fever and intraoperative bleeding, defined as hemoglobin drop. Over half patients had the MAP score ≧ 3. Men, elderly, chronic kidney disease, and diabetes were associated with a higher MAP score. The patients with a higher MAP score were more likely to have postoperative fever after mPCNL. On multivariate analysis, preoperative positive urine culture (OR 2.68) and a higher MAP score (OR 2.28) were both significantly associated with postoperative fever. ROC curves analysis of the combination of these two factors on predicting postoperative fever showed AUC values were 0.731 (0.652-0.810). Moreover, a higher MAP score (OR 2.30) and longer operative time (OR 2.16) were significantly associated with higher hemoglobin drop on multivariate analysis. A high MAP score was associated with postoperative fever and intraoperative hemorrhage in patients undergoing mPCNL. The MAP score can be a novel and easy predictive tool to help endourologists improve the awareness of mPCNL safety.

Effect of adherent perinephric fat on outcomes of nephron-sparing treatment of renal cell cancer

Introduction. Nephrometric scales have been developed to determine the appropriate surgical tactics and to predict intraoperative values more accurately, considering the characteristics of the renal tumour. However, there is a need to assess the perinephric fat. The Mayo Adhesive Probability (MAP) scale aims to identify adherent perinephric fat (APF) or 'complex' paranephric fat preoperatively.Objective. To evaluate the effect of APF on intraoperative and functional outcomes of patients with renal cell cancer (RCC) who underwent laparoscopic partial nephrectomy.Materials &amp; methods. We analysed 118 patients with localised RCC who underwent laparoscopic partial nephrectomy. At the preoperative stage, according to the results of contract-enhanced msCT, the presence of APF was assessed using the MAP scale. At the same time, the thickness of the posterior perinephric fat was measured and the grade of its twisting was assessed. As a result, the patients were divided into two groups: group 1 MAP 0 – 2 pts (no APF) 34 patients and group 2 MAP 3 – 5 pts (presence of APF) 84 patients. In each group, the following indicators were assessed: stage according to the TNM classification, mean age and BMI, average nephrometry score according to the R.E.N.A.L. system, glomerular filtration rate (GFR).Results. The median surgery time for group 1 patients was 115.0 [92.5; 142.5] min, for group 2 — 130.0 [101.3; 180.0] min. The median warm ischemia time in patients in group 1 was 15 [0; 20] min, in group 2 — 12 [0; 18] min. The median blood loss in the groups 1 and 2 was 50 [15; 100] and 50 [0; 100] ml, respectively. The mean GFR on the first day after surgery was 63.34 ± 18.40 ml/min/1.73 m2 in group 1 and 55.09 ± 16.01 ml/min/1.73 m2 in group 2. Openings of the pyelocalyceal system were observed in 8 (23.53%) and 23 (27.38%) patients in groups 1 and 2, respectively. A positive surgical margin was detected one patient in group 1 and two in group 2. Early postoperative complications in group 1 were four patients and group 2 — 15 patients.Conclusion. The presence of APF and its severity can be effectively assessed using the MAP score, which is promising, but is limited only to the prognostic of APF without correlation with nephrometric scales that assess tumour anatomy parameters. However, the issue of developing a unified assessment system that includes APF and kidney morphometry is currently open, and the definition of APF is still subjective and requires an objective analysis to obtain more accurate outcomes.

Validation of MAP (Mayo Adhesive Probability) score and preoperative factors to predict adherent perinephric fat in robotic-assisted partial nephrectomy

BackgroundMayo Adhesive Probability (MAP) score is based on posterior perinephric fat thickness and perinephric fat stranding and ranges from 0 to 5. We intend to validate the score and identify preoperative factors predictive of Adherent Perinphric Fat (APF) encountered in robotic-assisted partial nephrectomy.MethodsThe retrospective and prospective observational study was done at a single tertiary care hospital after appropriate ethical clearance. Sixty-two patients with clinical stage cT1 renal mass planned for robotic-assisted partial nephrectomy were selected over a study period of 3 years after obtaining informed consent. Data that were collected included demographic details and perioperative details including CT renal angiography which was done in all patients preoperatively. Intraoperative and postoperative data were collected. Associations of patient and tumor characteristics with the presence of APF during RAPN were evaluated by multivariable logistic regression models and using Chi-square test to calculate p value.ResultsOut of total 62 patients included; 24 patients (38.7%) had intraoperative Adhesive Perinephric Fat (APF). Three patients required conversion to open surgery and three patients underwent conversion to radical nephrectomy. Thirty-five patients were males. Mean age was 51.27(20–77) years. We noted an increased likelihood of APF with an increase in age (p = 0.003), higher preoperative creatinine (p = 0.003), greater posterior perinephric fat thickness (p = 0.002), and perirenal fat stranding (p < 0.001). From these four variables, posterior perinephric fat thickness and fat stranding were the most predictive. The combined score given to these two highly predictive factors for APF and the calculated score, termed Mayo Adhesive Probability (MAP) score ranges from 0 to 5. APF was seen in 10.7% of patients with a MAP score of 0, 25% with a score of 1, 50% with a score of 2, 44.4% with a score of 3, 88.8% with a score of 4, and 100% of patients with a score of 5 was found. Our study validates the MAP score given by Davidiuk et al. Smoking, high BMI, Sex of patient, tumor size, lateral perinephric fat thickness do not significantly predict APF in our study.ConclusionMAP score can be easily calculated from a CT scan. We validate the MAP score in RAPN. Higher MAP score has higher APF which would be useful to all urologists doing RAPN.

The Effect of the MAYO Adhesive Probability Score on Intraoperative Parameters in Laparoscopic Live Donor Nephrectomy and Bench Surgery

The Effect of the MAYO Adhesive Probability Score on Intraoperative Parameters in Laparoscopic Live Donor Nephrectomy and Bench Surgery

MP23-02 USE OF MAYO ADHESIVE PROBABILITY SCORE AS A PREDICTOR OF POSTOPERATIVE FEVER FOLLOWING mPCNL

You have accessJournal of UrologyCME1 Apr 2023MP23-02 USE OF MAYO ADHESIVE PROBABILITY SCORE AS A PREDICTOR OF POSTOPERATIVE FEVER FOLLOWING mPCNL Chia-Min Liu and Chan Jung Liu Chia-Min LiuChia-Min Liu More articles by this author and Chan Jung LiuChan Jung Liu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) is the standard treatment for large renal stone. Despite the advanced techniques, postoperative fever and bleeding remain the two major complications but still without effective predictor. Mayo adhesive probability (MAP) score is an image-based renal morphometry scoring system that is used to predict the potential risks and complications of partial nephrectomy but was never evaluated for the association with post-PCNL complications. We aim to explore the predictive value of MAP score on postoperative fever and estimated total blood loss (ETBL) in patients underwent miniaturized PCNL (mPCNL). METHODS: This is a retrospective study recruiting 159 mPCNL patients from July 2018 to January 2022. MAP scores was determined on the basis of pre-operative computed tomography and was calculated algorithmically by posterior renal fat thickness and the extent of perinephric fat stranding. We used Bourke and Smith formula to calculate intraoperative ETBL. Logistic regression analysis was used to determine independent risk factors associated with fever and ETBL. The predictive values of preoperative urine culture combining MAP score for postoperative fever was determined by receiver operating characteristic (ROC) curve analysis. RESULTS: Among 159 study subjects, over half of the patients presented with MAP score ≥ 3 (n=90, 56.6%). Men, elderly, chronic kidney disease, and diabetes mellitus were associated with a higher MAP score. The patients with higher MAP score were more likely to have postoperative fever after mPCNL. On multivariate logistic regression, preoperative positive urine culture (OR 2.44, p=0.01) and a higher MAP score (OR 2.13, p=0.026) were both significantly associated with postoperative fever. ROC curves analysis combining these two factors on predicting postoperative fever showed AUC 0.73 (0.652–0.810) (Figure 1). The posterior perinephric fat thickness was significantly associated with ETBL (β=7.36, p=0.04). CONCLUSIONS: The MAP score was associated with postoperative fever in patients undergoing mPCNL, while posterior perinephric fat demonstrated borderline association with estimated perioperative blood loss volume. The combination of preoperative urine culture and the MAP score can significantly predict the probability of fever in patients receiving mPCNL. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e306 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chia-Min Liu More articles by this author Chan Jung Liu More articles by this author Expand All Advertisement PDF downloadLoading ...

MP47-10 TWO-DIMENSIONAL SHEAR WAVE ELASTOGRAPHY: A PROMISING TOOL IN PREDICTING ADHERENT PERINEPHRIC FAT IN ROBOT-ASSISTED PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP47-10 TWO-DIMENSIONAL SHEAR WAVE ELASTOGRAPHY: A PROMISING TOOL IN PREDICTING ADHERENT PERINEPHRIC FAT IN ROBOT-ASSISTED PARTIAL NEPHRECTOMY Francesca Ambrosini, Francesco Chierigo, Veronica Giasotto, Guano Giovanni, Giovanni Marchi, Marco Martiriggiano, Giulia Carboni, Andrea Sorrentino, Guglielmo Mantica, Marco Borghesi, and Carlo Terrone Francesca AmbrosiniFrancesca Ambrosini More articles by this author , Francesco ChierigoFrancesco Chierigo More articles by this author , Veronica GiasottoVeronica Giasotto More articles by this author , Guano GiovanniGuano Giovanni More articles by this author , Giovanni MarchiGiovanni Marchi More articles by this author , Marco MartiriggianoMarco Martiriggiano More articles by this author , Giulia CarboniGiulia Carboni More articles by this author , Andrea SorrentinoAndrea Sorrentino More articles by this author , Guglielmo ManticaGuglielmo Mantica More articles by this author , Marco BorghesiMarco Borghesi More articles by this author , and Carlo TerroneCarlo Terrone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Mayo Adhesive Probability (MAP) score predicts the presence of adherent perinephric fat (APF) which may increase the surgical complexity of partial nephrectomy. We assessed the role of 2D shear-wave elastography (SWE) in predicting the presence of APF with the goal to describe a novel model for the preoperative assessment of patients submitted to robot-assisted partial nephrectomy (RAPN). METHODS: Consecutive patients submitted to RAPN were prospectively enrolled between January 2021 and January 2022. Data were collected regarding patients’ characteristics, tumor features (RENAL, PADUA, SPARE score, MAP score ). Presence of APF was defined by the surgeon intraoperatively. Perirenal fat stiffness was preoperatively assessed with two-dimensional (2D) SWE. Each sampling was repeated 3 times and the mean value was recorded. We relied on multivariable logistic regression models to test whether APF was associated with higher values of mean SWE, gender, BMI, and MAP score. Models’ predictive ability of the presence of APF was assessed using the concordance index (C-index). Linear regression models investigated the association between APF and OT. RESULTS: 55 patients were collected of whom 31 (56%) did not have APF and 24 (44%) had APF. No statistically significant differences were reported among patients with or without APF with regards to age, preoperative creatinine and glomerular filtration rate, gender, BMI, smoking habit, diabetes, and cT stage. Hypertension was reported in 17 (71%) out of 24 patients with APF and in 13 (42%) patients out of 31 without APF (p=0.033).In single-variable analysis, there was a significantly increased likelihood of APF in males (92% VS 8,3% p=0.004) and in patients with a higher median (IQR) SWE (9.0 (8.0, 11.5) VS 5.8 (4.8, 7.0) p<0.001).MAP score had a good predictive ability of APF on its own (C-index = 0,876). The model including SWE alone had a similar predictive value (C-index = 0,84).The most effective model in predicting APF included SWE, gender and BMI (C-index = 0,91).The median (IQR) OT was 160 (132 – 182) minutes and 185 (179 – 222) minutes in patients without or with APF, respectively (p=0.01).The linear regression analysis showed that the presence of APF is associated with higher total OT (R squared = 0,097, p=0.012). CONCLUSIONS: The multivariable model including gender, BMI and the mean value of three measures of SWE highly predicts the presence of APF. The presence of APF impacts the total OT. A larger sample size is needed to validate the model and to create a score that effectively predicts APF. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e648 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesca Ambrosini More articles by this author Francesco Chierigo More articles by this author Veronica Giasotto More articles by this author Guano Giovanni More articles by this author Giovanni Marchi More articles by this author Marco Martiriggiano More articles by this author Giulia Carboni More articles by this author Andrea Sorrentino More articles by this author Guglielmo Mantica More articles by this author Marco Borghesi More articles by this author Carlo Terrone More articles by this author Expand All Advertisement PDF downloadLoading ...

Mayo Adhesive Probability Score Does Not Have Prognostic Ability in Locally Advanced Renal Cell Carcinoma.

Nephrectomy remains standard treatment for renal cell carcinoma (RCC). The Mayo Adhesive Probability (MAP) score is predictive of adherent perinephric fat and associated surgical complexity, and is determined by assessing perinephric fat and stranding. MAP has additionally predicted progression-free survival (PFS), though primarily reported in stage T1-T2 RCC. Here, we examine MAP's ability to predict overall survival (OS) and PFS in T3-T4 RCC. From our prospectively maintained RCC database, patients that underwent radical nephrectomy (2009-2016) with available abdominal imaging (<90 days preop) and T3/T4 RCC underwent MAP scoring. Survival analyses were conducted with MAP scores as individual (0-5) and dichotomized (0-3 vs 4-5) using Kaplan-Meier method. Multivariable Cox proportional hazard regression models for PFS and OS were built with backward elimination. 141 patients were included. 134 (95%) and 7 (5%) had pT3 and pT4 disease, respectively. 46.1% of patients had an inferior vena cava thrombus. Mean MAP score was 3.22±1.52, with 75 (53%) patients having a score between 0-3 and 66 (47%) having a score of 4-5. Both male gender (p=0.006) and clear cell histology (p=0.012) were associated with increased MAP scores. On Kaplan-Meier and multivariable analysis, no significant associations were identified between MAP and PFS (HR=1.01, 95% CI 0.85-1.20, p=0.93) or OS (HR=1.01, 95% CI 0.84-1.21, p=0.917). In this cohort of patients with locally advanced RCC, high MAP scores were not predictive of worse PFS or OS.

Impact of perinephric fat volume and the Mayo Adhesive Probability score on time to clamping in robot-assisted partial nephrectomy.

The aim of this study is to evaluate the association of perinephric fat volume (PNFV) and the Mayo Adhesive Probability (MAP) score with time to clamping (TTC) in robot-assisted partial nephrectomy (RAPN). The study subjects consisted of 73 tumors in 72 patients who underwent transperitoneal RAPN at a single cancer center between February 2020 and July 2022. Clinical characteristics including R.E.N.A.L. nephrometry score, MAP score and PNFV were evaluated in a multivariate analysis in relation to TTC, which was classified into two groups based on median TTC. PNFVand MAP score were analyzed separately. PNFVs were measured by SYNAPSE VINCENT® by a single expert urologist. Median TTC was 67 (range: 36-119) min. Spearman's rank correlation analysis indicated that a significant correlation was observed between PNFV and MAP score with a value of 0.81 (p < 0.0001). Univariate analysis revealed that R.E.N.A.L. nephrometry score ≥ 7 (p = 0.036), posterior tumor location (p = 0.033), MAP score ≥ 3 (p = 0.02) and PNFV ≥ 250ml (p = 0.02) were significant factors for prolonged TTC. In a multivariate analysis including PNFV (analysis 1), R.E.N.A.L. nephrometry score ≥ 7 (OR 3.54, p = 0.018) and PNFV ≥ 250cm3 (OR 3.94, p = 0.010) were independent factors for prolonged TTC. Similarly for MAP score (analysis 2), R.E.N.A.L. nephrometry score ≥ 7 (OR 3.54, p = 0.018) and MAP score ≥ 3 (OR 3.94, p = 0.010) were independent factors for prolonged TTC. Both MAP score and PNFV may have a significant impact on TTC.

Intraoperative Ultrasound Can Facilitate Laparoscopic Partial Nephrectomy in Adherent Perinephric Fat.

Background: Adherent perinephric fat (APF) is one of the challenging factors of laparoscopic partial nephrectomy (LPN). The aim of this study was to investigate the effect of intraoperative laparoscopic ultrasound (ILUS) on determining renal tumor localization and dissection in patients with APF who underwent LPN. Methods: Prospectively collected data from 517 patients who underwent LPN from October 2010 to September 2020 in tertiary university hospital were evaluated retrospectively. The cohort was divided into two main groups according to the Mayo Adhesive Probability (MAP) score: Group 1 (MAP score ≤3) and Group 2 (MAP score ≥4). After implementing propensity score-matched analysis including the complexity of tumor, age, and body mass index, Group 1 consisted of 202 patients with ≤3 MAP score and Group 2 included 46 patients. Then, both groups were allocated into two subgroups according to whether ILUS was used. Demographics, perioperative features such as perirenal fatty tissue dissection, tumor excision, operation time, and perioperative outcomes accepted as trifecta, considering warm ischemia time, negative surgical margin, and complications were compared. Results: In Group 1, ILUS use did not seem to affect perioperative outcomes in both subgroups. However, ILUS has a positive effect on perirenal fatty tissue dissection (10 versus 19 minutes, P = .011), tumor excision (4 versus 7 minutes, P = .005), and operation time (78 versus 90 minutes, P = .046) in Group 2. Trifecta outcomes were also better in higher MAP scores and ultrasound-used subgroups (P = .019). Conclusions: ILUS should be considered a helpful and effective instrument in overcoming APF in LPN. It might also have a positive effect on trifecta outcomes.

P107 - The role of Mayo Adhesive Probability score in operative outcomes: A single center prospective analysis

P107 - The role of Mayo Adhesive Probability score in operative outcomes: A single center prospective analysis

SC184 - The relationship between adherent perinephric fat and the mayo adhesive probability (MAP) score and post-operative functional outcomes in patients subjected to robot-assisted partial nephrectomy

SC184 - The relationship between adherent perinephric fat and the mayo adhesive probability (MAP) score and post-operative functional outcomes in patients subjected to robot-assisted partial nephrectomy

SC186 - Prospective validation of the mayo adhesive probability score: a single center analysis

SC186 - Prospective validation of the mayo adhesive probability score: a single center analysis

Comparison of perinephric fat measurements between malignant and benign renal tumours.

ObjectiveTo investigate different parameters derived from the quantity and quality of perinephric fat, and to compare their effectiveness in predicting the malignant pathology of renal tumours.MethodsData from patients diagnosed with renal tumour between April 2014 and December 2020 were retrospectively reviewed, and patients were categorized into malignant or benign tumour groups. Fat parameters, including perinephric fat volume (PFV), perinephric fat area (PFA), perinephric fat thickness (PFT), and Mayo adhesive probability (MAP) score were measured using abdominal computed tomography scans. Between-group differences were assessed by analysis of variance and χ2-test. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the performance of perinephric fat parameters in diagnosing malignancy.ResultsA total of 109 patients were included. MAP score, PFV, PFA, and PFT were significantly increased in the malignant versus benign tumour group, and after correction for body mass index (BMI), the indexed PFV/BMI, PFA/BMI, and PFT/BMI values remained significantly higher in the malignant tumour group. All parameters showed fair predictivity of malignancy, with comparable area under the curve values in the ROC curve.ConclusionAn increased amount of perinephric fat is predictive of malignant pathology for renal tumours. The predictive accuracy for each perinephric fat parameter remained fair after correcting for BMI.