Excised Parenchymal Mass During Partial Nephrectomy

Functional Implications

Wen Dong, Zhiling Zhang, Juping Zhao, Jitao Wu, Chalairat Suk-Ouichai, Diego Aguilar Palacios, Elvis Caraballo Antonio, Sanam Babbar, Erick M. Remer, Jianbo Li, Sudhir Isharwal, Joseph Zabell, Steven C. Campbell

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective To evaluate whether excised parenchymal mass (EPM) during partial nephrectomy (PN) correlates with functional decline and can serve as a surrogate for functional outcomes. Materials and Methods All 215 patients managed with PN for unifocal renal mass with necessary studies to determine EPM and percent glomerular filtration rate (GFR) and parenchymal mass preserved (both global and specific to the operated kidney) were analyzed. EPM was estimated from the pathologic specimen by subtracting the tumor mass from the specimen mass, with both calculated using the elliptical formula. Vascularized parenchymal mass preserved was measured from computed tomography scans obtained <2 months prior and 3-12 months after surgery. All functional analyses were required to be within the same time frames, and patients with a contralateral kidney were also required to have nuclear renal scans. Results The median tumor size was 3.5 cm and the median R.E.N.A.L. was 7. Warm and cold ischemia were utilized in 123 and 92 patients, respectively (median ischemia time = 23 minutes). The median global GFR preserved was 89%, the median total parenchymal mass preserved was 93%, and the median estimated EPM was 16 cm3. Whereas percent parenchymal mass preserved correlated strongly with global and ipsilateral GFR preserved (both P < .001), EPM failed to correlate with functional outcomes on both univariable and multivariable analyses. Conclusion Our data suggest that parenchymal mass preserved with standard PN by experienced surgeons associates strongly with function preserved, whereas EPM fails to correlate with functional outcomes. Further study of the functional impact of EPM in other circumstances will be required, such as enucleation or PN performed by less-experienced surgeons.

Original languageEnglish (US)
Pages (from-to)129-135
Number of pages7
JournalUrology
Volume103
DOIs
StatePublished - May 1 2017
Externally publishedYes

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Nephrectomy
Glomerular Filtration Rate
Kidney
Cold Ischemia
Warm Ischemia
Neoplasms
Ischemia
Tomography
Surgeons

ASJC Scopus subject areas

  • Urology

Cite this

Dong, W., Zhang, Z., Zhao, J., Wu, J., Suk-Ouichai, C., Aguilar Palacios, D., ... Campbell, S. C. (2017). Excised Parenchymal Mass During Partial Nephrectomy: Functional Implications. Urology, 103, 129-135. https://doi.org/10.1016/j.urology.2016.12.021

Excised Parenchymal Mass During Partial Nephrectomy : Functional Implications. / Dong, Wen; Zhang, Zhiling; Zhao, Juping; Wu, Jitao; Suk-Ouichai, Chalairat; Aguilar Palacios, Diego; Caraballo Antonio, Elvis; Babbar, Sanam; Remer, Erick M.; Li, Jianbo; Isharwal, Sudhir; Zabell, Joseph; Campbell, Steven C.

In: Urology, Vol. 103, 01.05.2017, p. 129-135.

Research output: Contribution to journalArticle

Dong, W, Zhang, Z, Zhao, J, Wu, J, Suk-Ouichai, C, Aguilar Palacios, D, Caraballo Antonio, E, Babbar, S, Remer, EM, Li, J, Isharwal, S, Zabell, J & Campbell, SC 2017, 'Excised Parenchymal Mass During Partial Nephrectomy: Functional Implications', Urology, vol. 103, pp. 129-135. https://doi.org/10.1016/j.urology.2016.12.021
Dong W, Zhang Z, Zhao J, Wu J, Suk-Ouichai C, Aguilar Palacios D et al. Excised Parenchymal Mass During Partial Nephrectomy: Functional Implications. Urology. 2017 May 1;103:129-135. https://doi.org/10.1016/j.urology.2016.12.021
Dong, Wen ; Zhang, Zhiling ; Zhao, Juping ; Wu, Jitao ; Suk-Ouichai, Chalairat ; Aguilar Palacios, Diego ; Caraballo Antonio, Elvis ; Babbar, Sanam ; Remer, Erick M. ; Li, Jianbo ; Isharwal, Sudhir ; Zabell, Joseph ; Campbell, Steven C. / Excised Parenchymal Mass During Partial Nephrectomy : Functional Implications. In: Urology. 2017 ; Vol. 103. pp. 129-135.
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abstract = "Objective To evaluate whether excised parenchymal mass (EPM) during partial nephrectomy (PN) correlates with functional decline and can serve as a surrogate for functional outcomes. Materials and Methods All 215 patients managed with PN for unifocal renal mass with necessary studies to determine EPM and percent glomerular filtration rate (GFR) and parenchymal mass preserved (both global and specific to the operated kidney) were analyzed. EPM was estimated from the pathologic specimen by subtracting the tumor mass from the specimen mass, with both calculated using the elliptical formula. Vascularized parenchymal mass preserved was measured from computed tomography scans obtained <2 months prior and 3-12 months after surgery. All functional analyses were required to be within the same time frames, and patients with a contralateral kidney were also required to have nuclear renal scans. Results The median tumor size was 3.5 cm and the median R.E.N.A.L. was 7. Warm and cold ischemia were utilized in 123 and 92 patients, respectively (median ischemia time = 23 minutes). The median global GFR preserved was 89{\%}, the median total parenchymal mass preserved was 93{\%}, and the median estimated EPM was 16 cm3. Whereas percent parenchymal mass preserved correlated strongly with global and ipsilateral GFR preserved (both P < .001), EPM failed to correlate with functional outcomes on both univariable and multivariable analyses. Conclusion Our data suggest that parenchymal mass preserved with standard PN by experienced surgeons associates strongly with function preserved, whereas EPM fails to correlate with functional outcomes. Further study of the functional impact of EPM in other circumstances will be required, such as enucleation or PN performed by less-experienced surgeons.",
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AU - Aguilar Palacios, Diego

AU - Caraballo Antonio, Elvis

AU - Babbar, Sanam

AU - Remer, Erick M.

AU - Li, Jianbo

AU - Isharwal, Sudhir

AU - Zabell, Joseph

AU - Campbell, Steven C.

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N2 - Objective To evaluate whether excised parenchymal mass (EPM) during partial nephrectomy (PN) correlates with functional decline and can serve as a surrogate for functional outcomes. Materials and Methods All 215 patients managed with PN for unifocal renal mass with necessary studies to determine EPM and percent glomerular filtration rate (GFR) and parenchymal mass preserved (both global and specific to the operated kidney) were analyzed. EPM was estimated from the pathologic specimen by subtracting the tumor mass from the specimen mass, with both calculated using the elliptical formula. Vascularized parenchymal mass preserved was measured from computed tomography scans obtained <2 months prior and 3-12 months after surgery. All functional analyses were required to be within the same time frames, and patients with a contralateral kidney were also required to have nuclear renal scans. Results The median tumor size was 3.5 cm and the median R.E.N.A.L. was 7. Warm and cold ischemia were utilized in 123 and 92 patients, respectively (median ischemia time = 23 minutes). The median global GFR preserved was 89%, the median total parenchymal mass preserved was 93%, and the median estimated EPM was 16 cm3. Whereas percent parenchymal mass preserved correlated strongly with global and ipsilateral GFR preserved (both P < .001), EPM failed to correlate with functional outcomes on both univariable and multivariable analyses. Conclusion Our data suggest that parenchymal mass preserved with standard PN by experienced surgeons associates strongly with function preserved, whereas EPM fails to correlate with functional outcomes. Further study of the functional impact of EPM in other circumstances will be required, such as enucleation or PN performed by less-experienced surgeons.

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