Chalairat Suk-Ouichai1, Jitao Wu2, Wen Dong3, Hajime Tanaka4, Yanbo Wang5, J J H Zhang6, Elvis Caraballo6, Erick Remer7, Jianbo Li8, Sudhir Isharwal6, Steven C Campbell9. 1. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 2. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Yantai Yuhuangding Hospital, Yantai, Shandong, China. 3. 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. 4. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan. 5. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, First Hospital of Jilin University, Changchun, China. 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 contact surface area (CSA) between the tumor and parenchyma as a predictor of ipsilateral parenchyma and function preserved after partial nephrectomy (PN). Previous studies suggested that CSA is a strong predictor of functional outcomes but the limitations of CSA have not been adequately explored. PATIENTS AND METHODS: Four hundred nineteen patients managed with standard PN for solitary tumor with necessary studies to evaluate and analyze ipsilateral preoperative or postoperative parenchymal mass and function. Parenchymal mass and CSA were measured using contrast-enhanced computed tomography <2 months prior and 3-12months after PN. CSA was calculated: 2πrd, where r = radius and d = intraparenchymal depth. Pearson-correlation evaluated relationships between CSA and ipsilateral parenchymal mass or function preserved. Multivariable regression assessed predictors of function preserved. Conceptually, the CSA paradigm should function better for exophytic tumors than endophytic ones. RESULTS: Median tumor size was 3.5 cm and R.E.N.A.L. was 8. Median global and ipsilateral glomerular filtration rate preserved were 89% and 79%, respectively. Median ipsilateral parenchymal mass preserved was 85% and significantly higher for exophytic masses (P = .001). Median CSA was 22.8 cm2 and significantly less for exophytic masses (P = .02). CSA associated with both ipsilateral function and mass preserved (both P < .05), but the correlations were only modest (r = 0.25 and 0.36, respectively). On multivariable analysis, CSA associated with function preserved for exophytic masses (P = .01), but not for endophytic ones (P = .27). CONCLUSION: CSA associates with functional outcomes after standard PN, although the strength of the correlations was modest, unlike previous studies, and CSA was not an independent predictor for endophytic tumors. Further study will be required to evaluate the utility of CSA in various clinical settings.
OBJECTIVE: To evaluate contact surface area (CSA) between the tumor and parenchyma as a predictor of ipsilateral parenchyma and function preserved after partial nephrectomy (PN). Previous studies suggested that CSA is a strong predictor of functional outcomes but the limitations of CSA have not been adequately explored. PATIENTS AND METHODS: Four hundred nineteen patients managed with standard PN for solitary tumor with necessary studies to evaluate and analyze ipsilateral preoperative or postoperative parenchymal mass and function. Parenchymal mass and CSA were measured using contrast-enhanced computed tomography <2 months prior and 3-12months after PN. CSA was calculated: 2πrd, where r = radius and d = intraparenchymal depth. Pearson-correlation evaluated relationships between CSA and ipsilateral parenchymal mass or function preserved. Multivariable regression assessed predictors of function preserved. Conceptually, the CSA paradigm should function better for exophytic tumors than endophytic ones. RESULTS: Median tumor size was 3.5 cm and R.E.N.A.L. was 8. Median global and ipsilateral glomerular filtration rate preserved were 89% and 79%, respectively. Median ipsilateral parenchymal mass preserved was 85% and significantly higher for exophytic masses (P = .001). Median CSA was 22.8 cm2 and significantly less for exophytic masses (P = .02). CSA associated with both ipsilateral function and mass preserved (both P < .05), but the correlations were only modest (r = 0.25 and 0.36, respectively). On multivariable analysis, CSA associated with function preserved for exophytic masses (P = .01), but not for endophytic ones (P = .27). CONCLUSION:CSA associates with functional outcomes after standard PN, although the strength of the correlations was modest, unlike previous studies, and CSA was not an independent predictor for endophytic tumors. Further study will be required to evaluate the utility of CSA in various clinical settings.
Authors: N Heller; R Tejpaul; F Isensee; T Benidir; M Hofmann; P Blake; Z Rengal; K Moore; N Sathianathen; A Kalapara; J Rosenberg; S Peterson; E Walczak; A Kutikov; R G Uzzo; D A Palacios; E M Remer; S C Campbell; N Papanikolopoulos; Christopher J Weight Journal: J Urol Date: 2021-12-30 Impact factor: 7.600