Analysis of the impact of adherent perirenal fat on peri-operative outcomes of robotic partial nephrectomy

Khene, Z.; Peyronnet, B.; Mathiéu, Romain; Fardoun, T.; Verhoest, G.; Bensalah, Karim

doi:10.1007/s00345-015-1500-0

Cited by 75 publications

(96 citation statements)

References 19 publications

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“…The higher rate of conversion to radical nephrectomy was the main weakness of the off-clamp technique, given the similar rates of postoperative complications between both groups. This comparable rate of postoperative complication was in line with previous series [17,18] and might be explained by the multifactorial determinants of postoperative complications after PN, which may be influenced by the surgical technique but also patient and tumor's characteristics, perirenal fat, or surgeon's experience [9,20] .…”

Section: Discussionsupporting

confidence: 73%

Off-Clamp versus On-Clamp Robotic Partial Nephrectomy: A Multicenter Match-Paired Case-Control Study

Peyronnet¹,

Khene²,

Pradère³

et al. 2017

Urol Int

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Introduction: The aim of this study was to compare the outcomes of on-clamp and off-clamp robotic partial nephrectomy (RPN). Materials and Methods: The charts of all patients who underwent an RPN at 8 institutions between 2010 and 2014 were retrospectively reviewed. The patients who underwent an off-clamp RPN were matched to on-clamp RPN in a 1-4 fashion according to the following variables: RENAL score, tumor size and surgeon's experience. Pre-, intra-, and postoperative data were compared between both groups. Results: Among 525 RPN, 26 were performed off-clamp (5%). They were matched to 104 on-clamp RPN. The complications rate (15.5 vs. 7.7%, p = 0.53), major complications rate (4.9 vs. 3.9%; p = 0.82), and transfusions rate (0 vs. 4.9%; p = 0.58) did not differ significantly between the clamped and unclamped groups. Conversely, estimated blood loss was higher in the off-clamp group (266.4 vs. 284.6 mL, p = 0.048) and so was the rate of conversion to radical nephrectomy (0 vs. 7.7%, p = 0.04). Postoperative preservation of renal function was comparable in both groups. Conclusion: Off-clamp RPN is feasible for a small subgroup of renal tumors without increased risk of postoperative complications but at the cost of higher estimated blood loss and increased risk of conversion to radical nephrectomy.

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Section: Discussionsupporting

confidence: 73%

Off-Clamp versus On-Clamp Robotic Partial Nephrectomy: A Multicenter Match-Paired Case-Control Study

Peyronnet¹,

Khene²,

Pradère³

et al. 2017

Urol Int

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“…Our study is the first to evaluate the incidence of APF in Asian individuals with renal malignancy. The incidence of APF in our study was 17%, which was lower than the incidence rates in previous studies of Western cohorts (30-55%) [3,4,6,13]. BMI was associated with APF in this Asian cohort as it was in the Western cohorts, although the mean BMI (24 kg/m 2 ) in our study was smaller than those in Western studies (29-33 kg/m 2 ) [5,6,12].…”

Section: Discussioncontrasting

confidence: 55%

“…The current results showed, however, that Asians had a lower incidence of APF at lower BMI levels compared to Caucasians. The predictors of APF other than MAP score reported in the Western cohorts were male gender, older age, obesity, waist circumference, and hypertension [3][4][5]. The current study indicated that male gender was a strong predictor of APF in multivariate analysis, although other metabolic factors, including older age, higher BMI, smoking habit, and history of hypertension were not associated with the presence of APF.…”

Section: Discussionmentioning

confidence: 51%

“…During PN DOI: 10.1159/000494068 procedures, surgeons sometimes encounter sticky fat around the renal parenchyma which has been designated as adherent perinephric fat (APF). The presence of APF can increase the difficulty of tumor identification and exposure, and is associated with longer surgery duration and greater blood loss [3][4][5]. Therefore, the ability to predict the presence of APF before PN would be helpful, and it could help determine the surgical approach offered to each patient.…”

Section: Introductionmentioning

confidence: 99%

“…In that study, body mass index (BMI), male gender, and radiological findings were associated with APF, and a risk score was created according to radiological findings that were the only independent predictors of APF in multivariate analysis. MAP score is an accurate method of predicting APF, and it has been validated in several Western cohorts [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Adherent Perinephric Fat in Asian Patients: Predictors and Impact on Perioperative Outcomes of Partial Nephrectomy

Kawamura¹,

Saito²,

Inoue³

et al. 2018

Urol Int

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Introduction: This study is aimed at evaluating the incidence and predictors of adherent perinephric fat (APF) in Asians during partial nephrectomy (PN), and determining the impact of APF on perioperative outcomes. Materials and Methods: A total of 231 Asian patients with renal tumors underwent PN, and their Mayo adhesive probability (MAP) score was calculated. APF was intraoperatively determined, and the perioperative data were compared according to the presence of APF. The predictors of APF were examined using logistic regression analyses. Results: APF was observed in 40 (17%) patients. In multivariate analysis, male gender and higher MAP score were the independent predictors of APF. The estimated blood loss was higher in patients with APF, however, the complication rates did not differ between the 2 groups. Conclusions: The MAP score can predict APF in an Asian population. The presence of APF was associated with greater blood loss; however it did not increase the postoperative complications in PN.

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Indocyanine green‐marked fluorescence‐guided off‐clamp versus intraoperative ultrasound‐guided on‐clamp robotic partial nephrectomy: Outcomes on surgical procedure

Mazzoleni,

Perri,

Pacchetti

et al. 2023

BJUI Compass

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ObjectivesTo compare surgical and functional outcomes between off‐clamp robot‐assisted partial nephrectomy with indocyanine‐green tumour marking through preliminary superselective embolization and on‐clamp robot‐assisted partial nephrectomy with intraoperative ultrasound identification of the renal mass.Material and methodsOne hundred and forty patients with a single renal mass underwent indocyanine‐green fluorescence‐guided off‐clamp robot‐assisted partial nephrectomy with preoperative superselective embolization (Group A, 70 patients) versus intraoperative ultrasound‐guided on‐clamp robot‐assisted partial nephrectomy without embolization (Group B, 70 patients). We assessed operative time, intraoperative blood loss, complications, length of stay, renal function, need for ancillary procedures and blood transfusions.ResultsMean tumour size was 24 versus 25 mm in Group A versus Group B (p = 0.19). Mean operative time was 86.5 versus 121.8 min (p = 0.02), mean blood loss was 72.8 versus 214.2 mL (p = 0.02), and mean haemoglobin drop on postoperative day 1 was 1.1 versus 2.6 g/dL (p = 0.04) in Group A versus Group B. One‐month creatinine, hospital stay and enucleated tumour volume were comparable. Ten postoperative complications occurred in Group A (13.3%) and 11 in Group B (15.3%). Following superselective embolization, no patients required blood transfusions versus two patients in Group B. Postoperative selective renal embolization was needed in one case per group.ConclusionsPreoperative superselective embolization of a renal mass with indocyanine‐green before off‐clamp robot‐assisted partial nephrectomy significantly reduces operative time and intraoperative blood loss compared to on‐clamp intraoperative ultrasound‐guided robot‐assisted partial nephrectomy. A longer follow‐up is needed to establish the effect on renal function.

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Analysis of the impact of adherent perirenal fat on peri-operative outcomes of robotic partial nephrectomy

Abstract: During RPN, APF is associated with increased bleeding and a higher risk of conversion to open surgery and to radical nephrectomy. Male gender, hypertension, obesity, and MAP score are predictors of APF.

Cited by 75 publications

References 19 publications

Off-Clamp versus On-Clamp Robotic Partial Nephrectomy: A Multicenter Match-Paired Case-Control Study

Off-Clamp versus On-Clamp Robotic Partial Nephrectomy: A Multicenter Match-Paired Case-Control Study

Adherent Perinephric Fat in Asian Patients: Predictors and Impact on Perioperative Outcomes of Partial Nephrectomy

Indocyanine green‐marked fluorescence‐guided off‐clamp versus intraoperative ultrasound‐guided on‐clamp robotic partial nephrectomy: Outcomes on surgical procedure

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