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Parenchymal Mass Loss During Partial Nephrectomy: Role of Devascularized Parenchymal Mass and Excised Parenchymal Mass and Impact on Functional Preservation

  • Qi Liu
    Affiliations
    Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Guangdong Provincial Clinical Research Center for Urinary Diseases, Guangzhou, China
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  • Ming Gao
    Affiliations
    Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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  • Tian X. Lin
    Affiliations
    Guangdong Provincial Clinical Research Center for Urinary Diseases, Guangzhou, China
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  • Bei Liao
    Affiliations
    Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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  • Ya H. Wang
    Affiliations
    Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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  • Shao X. Wu
    Affiliations
    Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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  • Shi Z. Xu
    Affiliations
    Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Guangdong Provincial Clinical Research Center for Urinary Diseases, Guangzhou, China
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  • Jie X. Pan
    Affiliations
    Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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  • Zi X. Xu
    Affiliations
    Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Guangdong Provincial Clinical Research Center for Urinary Diseases, Guangzhou, China
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  • Jian Huang
    Affiliations
    Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Guangdong Provincial Clinical Research Center for Urinary Diseases, Guangzhou, China
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  • Wen Dong
    Correspondence
    Address for correspondence: Wen Dong, MD, PhD, Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
    Affiliations
    Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Guangdong Provincial Clinical Research Center for Urinary Diseases, Guangzhou, China
    Search for articles by this author
Published:December 16, 2021DOI:https://doi.org/10.1016/j.clgc.2021.12.007

      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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