To analyze predictors, extent and functional implications associated with renal parenchymal volume replacement (PVR) by renal cell carcinoma (RCC) prior to intervention. This phenomenon is well-recognized yet not adequately studied, and, if severe, can influence management.
A retrospective review was performed of partial nephrectomy (PN) and radical nephrectomy (RN) patients with available preoperative nuclear-renal-scan and imaging demonstrating solitary RCC with normal contralateral kidney. Normal renal parenchymal volume of each kidney was measured by free-hand scripting from preoperative axial images. Primary endpoint was percent PVR which was estimated assuming that the contralateral-kidney serves as a control: PVR=(volume contralateral kidney - volume ipsilateral kidney) normalized by volume contralateral kidney. Multivariable linear-regression analysis assessed factors associated with preoperative PVR. Further analysis evaluated the functional effect of PVR prior to surgery.
146 PN and 136 RN patients with necessary studies were analyzed. For RN, the median PVR was 15% and a quarter of patients had PVR ≥27%. In contrast, PVR was negligible in PN patients for whom median preoperative parenchymal volumes were nearly identical in the ipsilateral/contralateral kidneys (179/180cc, respectively). PVR inversely correlated with preoperative renal function in the ipsilateral kidney (p<0.01). Tumor-size (p<0.01), stage (p=0.03), and endophytic properties (p=0.03) associated with PVR on multivariable-analysis.
Our data suggest that substantial replacement of normal parenchyma by RCC occurs in many patients selected for RN and can contribute to preexisting renal-insufficiency. PVR prior to intervention is mainly driven by tumor characteristics in RN patients, but is negligible in most PN patients.
Urology. 2021 Oct 01 [Epub ahead of print]
Diego Aguilar Palacios, Rebecca A Campbell, Yosuke Yasuda, Gustavo Roversia Carlos Munoz-Lopez, Emily Abramczyk, Maureen Kelly, Elvis R Caraballo, Chalairat Suk-Ouichai, Lin Lin, Chris Weight, Robert Abouassaly, Steven C Campbell
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand., Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: .