Partial nephrectomy (PN) is standard for small renal masses, improving renal function by preserving renal parenchyma compared with radical nephrectomy. Recent work demonstrated that postoperative surgeon assessment of volume preservation (SAVP) and 3D imaging measurements agree and correlate with postoperative function. We hypothesize preoperative assessment of volume preservation (PAVP) with PN based on preoperative imaging will reliably indicate postoperative renal function.
Data were collected from 336 patients undergoing PN for suspected renal cancer by 40 surgeons at 12 centers in Europe and the United States within the Surface-Intermediate-Base International Consortium. Surgeons recorded PAVP and SAVP for individual patients; pre- and postoperative glomerular filtration rate (GFR) was estimated by Chronic Kidney Disease Epidemiology Collaboration equations. Correlations between PAVP, SAVP, and postoperative GFR were assessed with linear regression models. Bland-Altman analysis was used to assess agreement between PAVP and SAVP with a significant cutoff of 5%.
Median PAVP was 90% (interquartile range [IQR] 85%-100%) and SAVP was 90% (IQR: 80%-94%). PAVP and SAVP were moderately correlated (R2 = 0.67, P < 0.0001) and deemed "interchangeable" by Bland-Altman analysis at a 5% acceptable rate of difference (95% CI: -5.4, -3.1). Median postoperative GFR was 77.3 (IQR: 56.2, 92.0). Both PAVP (R2 = 0.82, P < 0.0001) and SAVP (R2 = 0.83, P < 0.0001) were correlated with postoperative GFR. Multivariable models utilizing volume-adjusted GFR based on PAVP or SAVP significantly and similarly predicted postoperative GFR (R2 = 0.72 for each).
Renal function is closely linked to the amount of parenchymal volume preservation, whether estimated prior to surgery (PAVP) or afterward (SAVP). PAVP provides reasonably accurate information for decision-making in patients considering PN.
Urologic oncology. 2018 Nov 22 [Epub ahead of print]
Michael J Klingler, Stephen K Babitz, Alexander Kutikov, Riccardo Campi, Georgios Hatzichristodoulou, Francesco Sanguedolce, Sabine Brookman-May, Bulent Akdogan, Umberto Capitanio, Marco Roscigno, Alessandro Volpe, Martin Marszalek, Robert G Uzzo, Alessandro Antonelli, Johan Langenhuijsen, Marco Carini, Andrea Minervini, Brian R Lane
Michigan State University College of Human Medicine, Grand Rapids, MI., Spectrum Health Hospital System, Grand Rapids, MI., Fox Chase Cancer Center, Philadelphia, PA., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany., Department of Urology, Southmead Hospital-North Bristol NHS Trust, Bristol, United Kingdom; Fundacio Puigvert, Autonomous University of Barcelona, Spain., Janssen Research & Development, Global Clinical Operations Germany; Department of Urology, Ludwig-Maximilians-University, Munich, Germany., Faculty of Medicine, Department of Urology, Hacettepe University, Ankara, Turkey., Department of Urology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy., Department of Urology, AO Papa Giovanni XXIII, Bergamo, Italy., Division of Urology, Maggiore della Carita' Hospital, University of Eastern Piedmont, Novara, Italy., Department of Urology, Graz Medical University, Graz, Austria., Fox Chase Cancer Center, Philadelphia, PA; Albert Einstein Medical Center, Philadelphia, PA., Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy., Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands., Michigan State University College of Human Medicine, Grand Rapids, MI; Spectrum Health Hospital System, Grand Rapids, MI. Electronic address: .