Three-dimensional virtual models (3DVMs) are nowadays under scrutiny to improve partial nephrectomy (PN) outcomes. This report aims to analyze their impact on renal function preservation after minimally invasive PN. A total of 100 patients treated with minimally invasive PN with contrast-enhanced computed tomography from which a 3DVM was obtained, and having undergone baseline and 3rd month postoperative renal scans were prospectively enrolled and compared with a control group of 251 patients without 3DVMs. Weighted differential of pre- and postoperative renal scan-based effective renal plasmatic flow (b-WD ERPF) was calculated, according to the availability of 3DVMs and PADUA risk category. Multivariable logistic regression (MLR) models predicting a significant loss of renal function (LORF; ERPF drop >20%) were performed, overall and according to PADUA risk categories. The b-WD ERPF of the 3DVM group showed significantly lower LORF (-10%) than that of the control group (-19.6%, p = 0.02). In MLR, the availability of a 3DVM was found to be the only protective factor against a significant LORF (odds ratio [OR] = 0.3, p = 0.002). Moreover, after stratification as per tumor surgical complexity, this protective role was observed in both PADUA 8-9 and ≥10 category risk patients (OR = 0.3, p = 0.03 and OR = 0.1, p = 0.01). PATIENT SUMMARY: The drop in operated kidney function was significantly lower in surgeries assisted by three-dimensional virtual models (3VDMs), indicating that the availability of a 3VDM is the only protective factor against a significant functional damage.
European urology oncology. 2021 Apr 23 [Epub ahead of print]
Daniele Amparore, Angela Pecoraro, Enrico Checcucci, Federico Piramide, Paolo Verri, Sabrina De Cillis, Stefano Granato, Tiziana Angusti, Federica Solitro, Andrea Veltri, Cristian Fiori, Francesco Porpiglia
Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano (Turin), Italy. Electronic address: ., Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano (Turin), Italy., Division of Radiology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano (Turin), Italy.