Wen Dong1, Zhiling Zhang2, Juping Zhao3, Jitao Wu4, Chalairat Suk-Ouichai5, Diego Aguilar Palacios6, Elvis Caraballo Antonio6, Sanam Babbar6, Erick M Remer7, Jianbo Li8, Sudhir Isharwal6, Joseph Zabell6, Steven C Campbell9. 1. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. 2. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. 3. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. 4. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Yantai Yuhuangding Hospital, Yantai, Shandong, China. 5. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 6. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. 7. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Imaging Institute, Cleveland Clinic, Cleveland, OH. 8. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH. 9. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: Campbes3@ccf.org.
Abstract
OBJECTIVE: To evaluate whether excised parenchymal mass (EPM) during partial nephrectomy (PN) correlates with functional decline and can serve as a surrogate for functional outcomes. MATERIALS AND METHODS: All 215 patients managed with PN for unifocal renal mass with necessary studies to determine EPM and percent glomerular filtration rate (GFR) and parenchymal mass preserved (both global and specific to the operated kidney) were analyzed. EPM was estimated from the pathologic specimen by subtracting the tumor mass from the specimen mass, with both calculated using the elliptical formula. Vascularized parenchymal mass preserved was measured from computed tomography scans obtained <2 months prior and 3-12 months after surgery. All functional analyses were required to be within the same time frames, and patients with a contralateral kidney were also required to have nuclear renal scans. RESULTS: The median tumor size was 3.5 cm and the median R.E.N.A.L. was 7. Warm and cold ischemia were utilized in 123 and 92 patients, respectively (median ischemia time = 23 minutes). The median global GFR preserved was 89%, the median total parenchymal mass preserved was 93%, and the median estimated EPM was 16 cm3. Whereas percent parenchymal mass preserved correlated strongly with global and ipsilateral GFR preserved (both P < .001), EPM failed to correlate with functional outcomes on both univariable and multivariable analyses. CONCLUSION: Our data suggest that parenchymal mass preserved with standard PN by experienced surgeons associates strongly with function preserved, whereas EPM fails to correlate with functional outcomes. Further study of the functional impact of EPM in other circumstances will be required, such as enucleation or PN performed by less-experienced surgeons.
OBJECTIVE: To evaluate whether excised parenchymal mass (EPM) during partial nephrectomy (PN) correlates with functional decline and can serve as a surrogate for functional outcomes. MATERIALS AND METHODS: All 215 patients managed with PN for unifocal renal mass with necessary studies to determine EPM and percent glomerular filtration rate (GFR) and parenchymal mass preserved (both global and specific to the operated kidney) were analyzed. EPM was estimated from the pathologic specimen by subtracting the tumor mass from the specimen mass, with both calculated using the elliptical formula. Vascularized parenchymal mass preserved was measured from computed tomography scans obtained <2 months prior and 3-12 months after surgery. All functional analyses were required to be within the same time frames, and patients with a contralateral kidney were also required to have nuclear renal scans. RESULTS: The median tumor size was 3.5 cm and the median R.E.N.A.L. was 7. Warm and cold ischemia were utilized in 123 and 92 patients, respectively (median ischemia time = 23 minutes). The median global GFR preserved was 89%, the median total parenchymal mass preserved was 93%, and the median estimated EPM was 16 cm3. Whereas percent parenchymal mass preserved correlated strongly with global and ipsilateral GFR preserved (both P < .001), EPM failed to correlate with functional outcomes on both univariable and multivariable analyses. CONCLUSION: Our data suggest that parenchymal mass preserved with standard PN by experienced surgeons associates strongly with function preserved, whereas EPM fails to correlate with functional outcomes. Further study of the functional impact of EPM in other circumstances will be required, such as enucleation or PN performed by less-experienced surgeons.
Authors: Fabio Crocerossa; Cristian Fiori; Umberto Capitanio; Andrea Minervini; Umberto Carbonara; Savio D Pandolfo; Davide Loizzo; Daniel D Eun; Alessandro Larcher; Andrea Mari; Antonio Andrea Grosso; Fabrizio Di Maida; Lance J Hampton; Francesco Cantiello; Rocco Damiano; Francesco Porpiglia; Riccardo Autorino Journal: Eur Urol Open Sci Date: 2022-03-03
Authors: Francesco Greco; Riccardo Autorino; Vincenzo Altieri; Steven Campbell; Vincenzo Ficarra; Inderbir Gill; Alexander Kutikov; Alex Mottrie; Vincenzo Mirone; Hendrik van Poppel Journal: Eur Urol Date: 2018-10-13 Impact factor: 24.267