Munich, Germany (UroToday.com) Partial nephrectomy is one of the most challenging urologic procedures. There are patient and tumor related factors to be considered preoperatively. Dariane and coauthors evaluated adherent perinephric fat (APF) and its effect on surgical outcomes following open or robotic partial nephrectomy.
Authors used the previously published Mayo adhesive probability score (MAP score) and calculated and compared to the per-operative surgical assessment of APF using a 0 to 3 scale (APF being defined by a score ≥ 2). Fat was analysed histologically for fibrosis (HES staining and picrosirius red) and inflammatory infiltrate of macrophages (HES and immunohistochemistry using anti-CD68 antibody).
A total of 125 patients were included in the study. APF was present in 41% of the patients, with no impact on surgical approach. Patients with APF had longer operating time and increased renal function impairement.
Interestingly, nn multivariate analysis, male gender (p = 0.002), age (p = 0.002), waist circumference (p = 0.039), fat density on CT in Hounsfield Unity (p= 0.038) and MAP score (p < 0.001) were significant predictors of APF.
Table 1 Predictors of APF and impact on peri-operative outcomes.
Authors suggested that APF should be used as a predictive factor for surgical planning. APF can be accurately predicted using preoperative imaging. APF is associated with increased operative time, blood loss and CKD stage impairment without impacting the rate of complications. Histological analysis of APF demonstrates significant fibrosis without inflammatory infiltrate.
Presented By:
Dariane C
From the 31st Annual EAU Congress - March 12 - 15, 2016 – Munich, Germany