Abstract
Objective
To investigate the relationship between postoperative renal function and resected
cortex margin volume calculated by a 3-dimensional reconstruction technique based
on the resected specimen, and to determine predictors of renal function after robot-assisted
partial nephrectomy.
Methods
A total of 114 patients underwent robot-assisted partial nephrectomy from 2014 to
2018. Patients without a 1 mm slice computed tomography or renal scintigraphy were
excluded. We identified the margins of the tumor from each resected specimen with
2 mm margin being added as the ischemic margin. The volume of the renal cortex was
calculated automatically using 3-dimensional volume analyzer software. The total margin
volume was excluded from the ipsilateral cortex volume to calculate the cortex volume
split. Predicted estimated glomerular filtration rate (eGFR) was calculated using
the change in cortex volume and then compared with the actual eGFR.
Results
Eighty-two patients were included in this retrospective study. Sixty-six patients
(80%) were cT1a. A strong correlation was observed between renal scintigraphy split
and pre- and postoperative cortex volume split (Pearson correlation coefficient r = 0.9330
and 0.8742, respectively). The predicted eGFR correlated strongly with post 1, 3,
6, and 12 months eGFR (r = 0.8929, 0.9294, 0.9320, and 0.8952, respectively). Preoperative
relative renal function and total cortex margin volume were independent risk factors
for decreasing postoperative renal function.
Conclusion
This precise volumetric assessment that includes the resected margin is an alternative
to renal scintigraphy for predicting postoperative relative renal function. The healthy
cortex margin volume calculated by the reconstruction technique is an independent
risk factor of decreasing postoperative renal function.
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Article info
Publication history
Published online: December 28, 2018
Accepted:
December 17,
2018
Received:
November 9,
2018
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
