AUA 2017: Excised Parenchymal Mass and Devascularized Parenchymal Mass

Boston, MA (UroToday.com) Researchers from the Cleveland Clinic investigated the impact of devascularized tissue, both the excised mass and the residual mass, on functional outcomes following renal artery clamping during partial nephrectomy (PN). Using computed tomography, they defined the excised parenchymal mass (EPM) as specimen volume—tumor volume and the devascularized parenchymal mass (DPM) as total parenchymal mass loss—EPM. Their study’s aim was to develop a method of measuring and evaluating how devascularized renal tissue during PN may or may not affect surgical outcomes.

The difference in the glomerular filtration rate preoperatively (74 mL/min/1.73m²) and postoperatively (67 mL/min/1.73m²) in their sample of 168 patients was not significant. Median EPM was 9 cc, DPM was 16 cc, and total parenchymal volume loss was 28 cc. On average, EPM consisted of 5% of the preoperative renal parenchymal mass, and DPM consisted of 8.6% of the preoperative renal parenchymal mass. Preservation of the glomerular filtration rate occurred in 79% of patients. Overall, DPM and EPM correlated positively with the total parenchymal mass loss; however, the relationship with DPM was stronger.

The excision of a renal mass during PN requires renal artery clamping to maintain hemostasis and control visualization in PN. The results of this study identify the importance of the devascularized tissue mass remaining after renal clamping and excision with respect to the inevitable loss of nephron mass and renal function. This finding suggests that modification of surgical technique or other intraoperative interventions may be required to minimize the loss of devascularized tissue (ie, DPM) in an already compromised kidney affected by a neoplasm. Furthermore, a technique to measure and evaluate EPM and DPM is accomplished using computed tomography and can be part of assessing the functional outcomes of PN. These metrics also may be important indicators of the impact of further modifications to PN and the preservation of renal function.

Presented By: Wen Dong, MD

Authors: Wen Dong, MD; Jitao Wu, MD; Chalairat Suk-Ouichai, MD; Elvis Carabello, MD; Diego Aguilar Palacios, MD; Erick Remer, MD; Jianbo Li, MDl Joseph Zabell, MD; Sudhir Isharwal, MD; Steven Campbell, MD
Institution: Cleveland Clinic, Cleveland, OH

Written By: Daniel Lama for UroToday.com

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA

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