Abstract
This study included 93 patients with renal masses who underwent standard partial nephrectomy
or tumor enucleation. After surgery, parenchymal mass loss caused by devascularization
resulted in more damage to renal function than excised parenchymal mass loss. Surgeons
should seek better techniques to decrease devascularization during reconstruction.
Introduction
To evaluate the importance of devascularized parenchymal mass(DPM) and excised parenchymal
mass(EPM) in functional preservation after standard partial nephrectomy(SPN).
Patients and Methods
Forty-one patients who underwent pure tumor enucleation(TE) and 52 patients who underwent
SPN with necessary data were included. As no EPM was lost in TE, the TE samples were
used to estimate the degree of volume shrinkage that occurred when the measurements
were performed in vivo with blood flow versus ex vivo without, and the shrinkage ratio
was calculated as specimen volume divided by tumor volume in vivo. In SPN, the specimen
volume comprised tumor volume plus EPM. The EPM was calculated as specimen volume
divided by shrinkage ratio minus tumor volume in vivo. The DPM was defined as total
ipsilateral parenchymal mass loss minus EPM. T tests, χ2 test, and Mann–Whitney U tests were employed to compare clinical characteristics. Multivariate analysis was
used to identify variables that correlated with glomerular filtration rate(GFR) preservation.
Results
The mean sizes of devascularized and excised parenchymal masses were 13.6 cm3 and 5.2 cm3 (P = .01), which accounted for 7.8% and 3.4% of preoperative ipsilateral parenchymal
mass (P = .03) in SPN, respectively. The shrinkage ratio was 0.71 and correlation coefficient
was 0.965. After stepwise regression, DPM, and preoperative GFR were significantly
associated with global GFR preservation.
Conclusion
The DPM comprises most of parenchymal mass loss after SPN and plays a more important
role than EPM on functional outcomes. Surgeons should pay more attention to reducing
devascularization during partial nephrectomy.
Keywords
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Article info
Publication history
Published online: December 16, 2021
Accepted:
December 12,
2021
Received in revised form:
December 9,
2021
Received:
October 31,
2021
Footnotes
Q.L. and M.G. contributed equally to this work.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.