Devascularized parenchymal mass tied to functional outcome after partial nephrectomy
Devascularized, compared with excised, parenchymal mass has more impact on functional recovery following partial nephrectomy, and this may have implications with respect to surgical technique, a recent study has found.
“Parenchymal mass loss is the predominant factor associated with functional outcomes after partial nephrectomy. It is primarily due to excised and/or devascularized parenchymal mass,” researchers said.
Researchers analysed a total of 168 patients who underwent partial nephrectomy to determine excised and devascularized parenchymal mass and to assess parenchymal mass changes and functional loss of the operated kidney. They also measured parenchymal mass loss in the ipsilateral kidney on contrast-enhanced computed tomography <2 months before and 3 to 12 months after partial nephrectomy.
Excised parenchymal mass was defined as specimen volume minus tumour volume. Devascularized parenchymal mass was estimated by subtracting excised parenchymal mass from total parenchymal mass loss.
Pearson correlation was used to assess relationships between glomerular filtration rate preservation and parenchymal mass loss. Researchers used multivariable analysis to evaluate factors linked to devascularized parenchymal mass.
Median R.E.N.A.L. (radius, exophytic/endophytic tumour properties, nearness of tumour to collecting system or sinus, anterior/posterior and location relative to polar lines) was 7 and median tumour size was 3.4 cm. Warm ischaemia was used in 100 patients and cold ischaemia in 68.
Median devascularized parenchymal mass was 16 cm3 and median excised parenchymal mass 9 cm3 (p<0.001). Total parenchymal mass loss and devascularized parenchymal mass strongly correlated with glomerular filtration rate preservation in the operated kidney (r≥0.55; p<0.001 for both). However, only a weak association existed between excised parenchymal mass and functional outcomes (r=0.23).
Multivariable analysis revealed that the preoperative glomerular filtration rate and endophytic status were associated with devascularized parenchymal mass.
“Prospective study is required to further evaluate the relative contributions of excised and devascularized parenchymal mass in various settings,” researchers said.