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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References
- Feasibility of omitting cortical renorrhaphy during robot-assisted partial nephrectomy: a matched analysis.J Endourol. 2015; 29: 548-555
- The use of tissue adhesive for tumor bed closure during partial nephrectomy is associated with reduced devascularized functional volume loss.Curr Urol. 2019; 13: 82-86
- Devascularized parenchymal mass associated with partial nephrectomy: predictive factors and impact on functional recovery.J Urol. 2017; 198: 787-794
- Renal function after partial nephrectomy: effect of warm ischemia relative to quantity and quality of preserved kidney.Urology. 2012; 79: 356-360
- Renal volume matters: assessing the association between excisional volume loss and renal function after partial nephrectomy.Asian J Surg. 2020; 43: 257-264
- Excisional precision matters: understanding the influence of excisional volume loss on renal function after partial nephrectomy.Eur Urol. 2017; 72: 168-170
- The volume of nonneoplastic parenchyma in a minimally invasive partial nephrectomy specimen: predictive factors and impact on renal function.J Endourol. 2014; 28: 196-200
- A new equation to estimate glomerular filtration rate.Ann Intern Med. 2009; 150: 604-612
- Laparoscopic partial nephrectomy for T1 renal cell carcinoma: comparison of two resection techniques in a multi-institutional propensity score-matching analysis.Ann Surg Oncol. 2016; 23: 1395-1402
- Long-Term oncologic outcomes after laparoscopic and robotic tumor enucleation for renal cell carcinoma.Front Oncol. 2021; 10595457
- Functional recovery after partial nephrectomy: effects of volume loss and ischemic injury.J Urol. 2012; 187: 1667-1673
- Renal ischemia and functional outcomes following partial nephrectomy.Urol Clin North Am. 2017; 44: 243-255
- Decline in renal function after partial nephrectomy: etiology and prevention.J Urol. 2015; 193: 1889-1898
- Acute kidney injury after partial nephrectomy: role of parenchymal mass reduction and ischemia and impact on subsequent functional recovery.Eur Urol. 2016; 69: 745-752
- Analysis of atrophy after clamped partial nephrectomy and potential impact of ischemia.Urology. 2015; 85: 1417-1422
- Association between warm ischemia time and renal parenchymal atrophy after partial nephrectomy.J Urol. 2013; 189: 1638-1642
- Effect of renal reconstruction on renal function after partial nephrectomy.J Endourol. 2016; 30: S37-S41
- Predictors of excisional volume loss in partial nephrectomy: is there still room for improvement?.Eur Urol. 2016; 70: 413-415
- Role of robot-assisted partial nephrectomy for renal cell carcinomas in the purpose of nephron sparing.Onco Targets Ther. 2019; 12: 8189-8196
- Robot-assisted partial nephrectomy: an international experience.Eur Urol. 2010; 57: 815-820
- Robot-assisted laparoscopic partial nephrectomy: step-by-step contemporary technique and surgical outcomes at a single high-volume institution.Eur Urol. 2012; 62: 553-561
- Functional significance of using tissue adhesive substance in nephron-sparing surgery: assessment by quantitative SPECT of 99m Tc-dimercaptosuccinic acid scintigraphy.Eur Urol. 2007; 52: 785-789
- Comparison of radiographic and pathologic sizes of renal tumors.World J Urol. 2010; 28: 263-267
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.
