Objective
To compare the surgical precision for optimizing nephron-mass preservation of tumor
enucleation (TE) vs standard partial nephrectomy (SPN), with primary focus on functional
outcomes. TE is presumed to optimize preservation of parenchymal mass and function
but this has not yet been rigorously studied and quantified.
Materials and Methods
Robotic partial nephrectomy patients who had appropriate pre- and postoperative studies
for analysis of parenchymal mass preservation specific to the operated kidney were
included. Computed tomography or magnetic resonance imaging and estimated glomerular
filtration rate were required to be <2 months prior and 4-12 months after surgery.
Parenchymal mass preservation and surgical precision were estimated for each technique,
with precision defined as actual postoperative parenchymal volume or predicted postoperative
parenchymal volume, presuming loss of a 5 mm rim of parenchyma associated with tumor
excision and reconstruction.
Results
Analysis included 57 TE and 53 SPN. Median age, body mass index, and tumor size were
comparable. Percent parenchymal mass preserved in the operated kidney with TE was
96% (interquartile range [IQR] = 90-100) vs 89% (IQR = 83-96) for SPN (P = .003). Precision of excision or reconstruction was 101% (IQR = 96-105) for TE vs
94% (IQR = 88-100) for SPN (P < .001). On multivariable analysis, only TE correlated with improved surgical precision
(coefficient = 6.7, 95% confidence interval = 1.6-11.8, P = .01). Although preservation of global renal function also favored TE, the differences
were marginal (96% vs 93%), and statistical significance was not observed (P = .2).
Conclusion
Our analysis, which specifically focuses on the functional implications of TE, demonstrates
that TE maximally spares normal parenchyma compared to SPN. Thus far, functional differences
remain marginal and not statistically significant. Clinical significance of these
findings in various clinical settings will require further investigation.
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Article info
Publication history
Published online: September 07, 2016
Accepted:
July 21,
2016
Received:
May 17,
2016
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
