1800 DOES OPERATIVE MODALITY IMPACT THE AMOUNT OF NORMAL RENAL PARENCHYMA REMOVED DURING PARTIAL NEPHRECTOMY?

You have accessJournal of UrologyKidney Cancer: Localized (V)1 Apr 20131800 DOES OPERATIVE MODALITY IMPACT THE AMOUNT OF NORMAL RENAL PARENCHYMA REMOVED DURING PARTIAL NEPHRECTOMY? Jennifer J. Ahn, Edan Y. Shapiro, Arindam RoyChoudhury, and James M. McKiernan Jennifer J. AhnJennifer J. Ahn New York, NY More articles by this author , Edan Y. ShapiroEdan Y. Shapiro New York, NY More articles by this author , Arindam RoyChoudhuryArindam RoyChoudhury New York, NY More articles by this author , and James M. McKiernanJames M. McKiernan New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2850AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) is the treatment of choice for small renal masses, and is associated with improved long-term renal function relative to radical nephrectomy. Additionally, studies have shown that post-operative renal function directly correlates with the percentage of renal parenchyma spared. While oncologic and perioperative outcomes are similar for laparoscopic (LPN), robotic (RPN), and open partial nephrectomy (OPN), it is not known if the operative modality affects the degree of parenchymal sparing. We sought to determine if the amount of normal renal parenchyma removed varies across open, laparoscopic, and robotic PN. METHODS We retrospectively reviewed the IRB-approved Columbia University Urologic Oncology Database to identify patients who underwent PN from 2009-2011. Pathology reports were reviewed to identify cases where dimensions of the overall specimen and tumor were detailed. Surgical specimen volumes (VS) and tumor volumes (VT) were estimated by the ellipsoid formula (V = 4/3πr1r2r3), and used to calculate the amount of resected renal parenchyma (VP = VS-VT) and percentage of parenchyma removed (V% = VP/VS). Linear regression analysis was performed to determine if type of surgery impacted the amount of normal renal parenchyma removed, when controlling for age and tumor size. RESULTS A total of 125 patients underwent PN for 133 renal masses. Mean preoperative tumor diameter was 3.3cm (1.0-8.2) on axial imaging. Patient and clinicopathologic characteristics are shown in Table 1. VT was greatest in the OPN group (24.0cm3), as compared to both the RPN (8.6 cm3) and LPN (9.5cm3) groups (p < 0.05). VP was also greatest in the OPN group (24.6 cm3), while V% was greatest in the LPN group. On regression analysis, surgical modality was not predictive of either VP or V%, while tumor size was predictive of both (p < 0.001). CONCLUSIONS These findings confirm that OPN is being utilized for larger renal masses, which results in resection of more normal renal parenchyma at time of surgery. However, when controlling for tumor size, the amount of parenchyma removed during PN is comparable across open, laparoscopic, and robotic approaches. Open PN Laparoscopic PN Robotic PN Overall N (%) 60 (45%) 36 (27%) 37 (28%) 133 Mean age (range) 63.7 (36-85) 55.2 (16-75)⁎ 60.4 (26-82) 60.4 (16-85) Mean preop tumor diameter in cm (range) 3.9 (1.5-8.2) 3.0 (1.0-6.5)⁎ 2.7 (1.2-5.6)⁎ 3.3 (1.0-8.2) Mean VS in cm3 (range) 48.6 (2.8-359.3) 29.2 (1.3-87.9)⁎ 20.8 (2.0-113.0) 35.6 (1.3-359.3) Mean VT in cm3 (range) 24.0 (0.9-227.0) 9.5 (0.4-48.6)⁎ 8.6 (0.5-44.0)⁎ 15.8 (0.4-227.0) Mean VP in cm3 (range) 24.6 (1.1-140.3) 15.9 (1.1-68.7)⁎ 12.2 (1.4-69.8) 19.8 (1.1-140.3) Mean V% (VP/VS) 58% 69%⁎ 63% 62% Mean surgical margin in mm (range) 1.9 (0-12) 1.8 (0-13) 1.7 (0-6) 1.8 (0-13) RCC 51 31 28 110 T1a 34 26 21 81 T1b 15 5 7 27 T2a 2 0 0 2 Benign Pathology 9 5 9 23 ⁎ p < 0.05 (open PN as ref) © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e739-e740 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer J. Ahn New York, NY More articles by this author Edan Y. Shapiro New York, NY More articles by this author Arindam RoyChoudhury New York, NY More articles by this author James M. McKiernan New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...