Contact surface area and its association with outcomes in robotic‐assisted partial nephrectomy

Kahn, Amanda E.; Shumate, Ashley M.; Galler, Isabella; Ball, Colleen T.; Thiel, David D.

doi:10.1002/rcs.2069

Cited by 4 publications

(7 citation statements)

References 13 publications

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“…Previous studies have reported that a higher CS is related to a longer warm ischemic time, higher estimated blood loss, longer duration of hospitalization, and decreased renal function. 13 However, to our knowledge, they did not reveal the relationship between the CS and CSE. For tumors showing a large contact area with the renal parenchyma, surgeons set the cutting line of the tumor wider because of the di culty in imaging the tumor depth and concerns regarding a positive surgical margin.…”

Section: Introductionmentioning

confidence: 62%

“…In previous reports, a higher CS was associated with a longer warm ischemic time, higher estimated blood loss, longer duration of hospitalization, and decreased renal function. 13 However, considering the lack of studies evaluating the in uence of CS on the occurrence of CSE, we analyzed this in uence by evaluating the relationship between CSE and CS in the present study.…”

Section: Discussionmentioning

confidence: 99%

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In which cases does collecting system entry occur in robot-assisted partial nephrectomy? Development of a novel predictive model based on the contact surface area of the tumor to the renal parenchyma

Umemoto

Hasegawa

Yuzuriha

et al. 2022

Preprint

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Background Collecting system entry in robot-assisted partial nephrectomy may occur even in cases showing a low N factor in the R.E.N.A.L nephrometry score. Therefore, we focused on the tumor contact surface area with the adjacent renal parenchyma and attempted to construct a novel predictive model for collecting system entry. Methods Among 190 patients who underwent robot-assisted partial nephrectomy at our institution from 2015 to 2021, 94 patients with a low N factor (12) were analyzed. Contact surface was measured with three-dimensional imaging software and defined as the C factor, classified as C1, < 10 cm2; C2, ≥ 10 and < 15 cm2; and C3: ≥ 15 cm2. Additionally, a modified R factor (mR) was classified as mR1, < 20 mm; mR2, ≥ 20 and < 40 mm; and mR3, ≥ 40 mm. We discussed the factors influencing collecting system entry, including the C factor, and created a novel collecting system entry predictive model. Results Collecting system entry was observed in 32 patients with a low N factor (34%). The C factor was the only independent predictive factor for collecting system entry in multivariate regression analysis (odds ratio: 4.195, 95% CI: 2.160–8.146, p < 0.0001). Models including the C factor showed better discriminative power than the models without the C factor. Conclusions The new predictive model, including the C factor in N1-2 cases, may be beneficial, considering its indication for preoperative ureteral catheter placement in patients undergoing robot-assisted partial nephrectomy.

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Section: Introductionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

In which cases does collecting system entry occur in robot-assisted partial nephrectomy? Development of a novel predictive model based on the contact surface area of the tumor to the renal parenchyma

Umemoto

Hasegawa

Yuzuriha

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Previous studies have reported that a higher CS is related to a longer warm ischemic time, higher estimated blood loss, longer duration of hospitalization, and decreased renal function. [ 13 ] However, to our knowledge, they did not reveal the relationship between the CS and CSE. For tumors showing a large contact area with the renal parenchyma, surgeons set the cutting line of the tumor wider because of the difficulty in imaging the tumor depth and concerns regarding a positive surgical margin.…”

Section: Introductionmentioning

confidence: 72%

“…In previous reports, a higher CS was associated with a longer warm ischemic time, higher estimated blood loss, longer duration of hospitalization, and decreased renal function. [ 13 ] However, considering the lack of studies evaluating the influence of CS on the occurrence of CSE, we analyzed this influence by evaluating the relationship between CSE and CS in the present study.…”

Section: Discussionmentioning

confidence: 99%

Impact of tumor contact surface area on collecting system entry in robot-assisted partial nephrectomy: a retrospective analysis

et al. 2023

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Background Collecting system entry in robot-assisted partial nephrectomy may occur even in cases showing a low N factor in the R.E.N.A.L nephrometry score. Therefore, in this study, we focused on the tumor contact surface area with the adjacent renal parenchyma and attempted to construct a novel predictive model for collecting system entry. Methods Among 190 patients who underwent robot-assisted partial nephrectomy at our institution from 2015 to 2021, 94 patients with a low N factor (1–2) were analyzed. Contact surface was measured with three-dimensional imaging software and defined as the C factor, classified as C1, < 10 cm [2]; C2, ≥ 10 and < 15 cm [2]; and C3: ≥ 15 cm [2]. Additionally, a modified R factor (mR) was classified as mR1, < 20 mm; mR2, ≥ 20 and < 40 mm; and mR3, ≥ 40 mm. We discussed the factors influencing collecting system entry, including the C factor, and created a novel collecting system entry predictive model. Results Collecting system entry was observed in 32 patients with a low N factor (34%). The C factor was the only independent predictive factor for collecting system entry in multivariate regression analysis (odds ratio: 4.195, 95% CI: 2.160–8.146, p < 0.0001). Models including the C factor showed better discriminative power than the models without the C factor. Conclusions The new predictive model, including the C factor in N1-2 cases, may be beneficial, considering its indication for preoperative ureteral catheter placement in patients undergoing robot-assisted partial nephrectomy.

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“…15 As more vascularized renal parenchyma is likely to be included in tumors with high RNS (large diameter, hilar, and median polar location), a running suture for kidney reconstruction owes unavoidable risk of compromising intrarenal vascular anatomy. 24,25 Thus, it is reasonable to presume that efforts to preserve any little volume of parenchyma for these tumors are crucial to prevent acute kidney injury or CKD. However, the impact of the dissecting technique seemed relatively small in patients with low complexity tumors, but the difference was statistically significant (-1.1% vs -4.4%, p = 0.005).…”

Section: Discussionmentioning

confidence: 99%

Greater Renal Function Benefit from Enucleation Technique for More Complex Renal Tumors in Robot-Assisted Partial Nephrectomy

Ishiyama

Kondo

Tachibana

et al. 2021

Journal of Endourology

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Background: Tumor enucleation technique in robot-assisted partial nephrectomy (RAPN) reportedly contributes to renal function preservation. Which tumors and which part to utilize this technique have not been determined. Patients and Methods: This multi-institutional retrospective study included patients who underwent RAPN at tertiary surgery centers. Patients were first stratified into High, Intermediate, and Low categories based on renal nephrometry score. Patients were further classified into I/B-enucleation (I/B-E, I + B £ 1) and I/Bresection (I/B-R, I + B ‡ 2) groups based on surface-intermediate-base margin score. Perioperative outcomes, including percentile change in estimated glomerular filtration rate (eGFR), new-onset chronic kidney disease, complication rate, surgical margin, and trifecta achievement, were compared between the I/B-E and I/B-R groups in each category. Odds ratios (ORs) and b-coefficients were also compared.Results: Overall, 704 patients were included in this study. Relative decrease in eGFR was significantly lower for the I/B-E group in all three categories, with medians of 8.1%, 4.4%, and 3.2% in the High, Intermediate, and Low, respectively. In multivariate analyses, excision technique was independently associated with eGFR change in all three. b-coefficient was higher in the High (5.06) category than in the Low (3.17) or Intermediate (3.33). Across all three categories, significantly more patients attained trifecta with a difference of 34.0%, 18.3%, and 15.1% in the High, Intermediate, and Low categories, respectively (all, p < 0.05), with a higher OR in the High (5.91) category than in the Low (3.20) or Intermediate (2.48). No significant differences were found in operation time, amount of estimated blood loss, rate of positive surgical margin, or complications. Warm ischemic time was significantly longer for the I/B-E group in the Intermediate (18.0 minutes vs 16.0 minutes, p = 0.002) and Low categories (13.0 vs 11.0, p = 0.006), but not significant in High ( p = 0.344).Conclusions: I/B-enucleation in RAPN contributes to renal function preservation, and the impact was more emphasized in complex tumors.

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Contact surface area and its association with outcomes in robotic‐assisted partial nephrectomy

Cited by 4 publications

References 13 publications

In which cases does collecting system entry occur in robot-assisted partial nephrectomy? Development of a novel predictive model based on the contact surface area of the tumor to the renal parenchyma

In which cases does collecting system entry occur in robot-assisted partial nephrectomy? Development of a novel predictive model based on the contact surface area of the tumor to the renal parenchyma

Impact of tumor contact surface area on collecting system entry in robot-assisted partial nephrectomy: a retrospective analysis

Greater Renal Function Benefit from Enucleation Technique for More Complex Renal Tumors in Robot-Assisted Partial Nephrectomy

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