Effect of Visceral Obesity on Minimally Invasive Partial Nephrectomy

Ioffe, Edward; Hakimi, A. Ari; Oh, Sarah K.; Agalliu, Ilir; Ginzburg, Natasha; Williams, Steve K.; Kao, Linda; Rozenblit, Alla M.; Ghavamian, Reza

doi:10.1016/j.urology.2013.04.058

Cited by 28 publications

(42 citation statements)

References 12 publications

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“…De manière similaire, on sait que le tissu adipeux se redistribue chez les personnes plus âgées, de l'espace sous-cutané vers les viscères intra-abdominaux, en particulier le long de la moelle osseuse, du foie et des reins, expliquant la corrélation retrouvée entre l'âge et la GPA (77).Dans la littérature de manière similaire, il a été rapporté que la densité de la graisse périrénale(16), le sexe masculin(6,16,18,54) ainsi que l'âge (71) étaient des facteurs prédictifs de GPA mais notre étude est la première à rapporter le périmètre abdominal, utilisé dans la définition du syndrome métabolique(Figure 21), comme un des critères cliniques les plus prédictifs de GPA. Par ailleurs, un score radio-clinique combinant le MAP score avec le sexe masculin et le périmètre abdominal semblait également plus prédictif de présence de GPA que le MAP score seul.De manière notable, aucune corrélation entre l'IMC et une augmentation de la complexité chirurgicale de la NP n'a été rapporté dans la littérature(55). De manière semblable dans notre étude, une augmentation de l'IMC n'était pas associée à la présence de GPA après analyse multivariée, mais seuls l'épaisseur de la graisse péri-rénale utilisée dans le MAP score et le périmètre abdominal restaient significatifs.…”

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Prospective assessment and histological analysis of adherent perinephric fat in partial nephrectomies

Dariane

Guilchet

Hurel

et al. 2017

Urologic Oncology: Seminars and Original Investigations

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Prospective assessment and histological analysis of adherent perinephric fat in partial nephrectomies

Dariane

Guilchet

Hurel

et al. 2017

Urologic Oncology: Seminars and Original Investigations

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“…Perinephric fat was found to be significantly correlated with operative time in renal procedures while BMI had no correlation with operative time (36). However, other studies found no association between obesity (either measured by visceral and perinephric fat or by BMI) and surgical outcomes in RPNx (37,38). When looking at a large study population, such as the NSQIP data base, there was no association between BMI and POC after OPN and MIPN (39).…”

Section: Resultsmentioning

confidence: 94%

The BMI Paradox and Robotic Assisted Partial Nephrectomy

et al. 2020

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Introduction: Partial nephrectomy (PN), has become the gold standard for the surgical management of small renal masses, due to excellent oncologic control with concomitant preservation of nephron units. However, data regarding the association of obesity with perioperative outcomes following PN are mixed. Therefore, the association between obesity (using BMI) and post-operative complications (POC) rate following Robotic assisted laparoscopic PN (RPNx) was tested. Methods: Two hundred and fifty-one adult patients who underwent RPNx from 1/2011 to 5/2017 at a single institution, with at least 90 days follow-up were identified and included. No patients were excluded. Electronic medical records were reviewed to record all POC within 90 days of surgery. A piecewise generalized linear model for binary outcomes (logistic) was used to model the proportion of subjects with POC by their BMI. The slope of the line is adjusted to a BMI of 30 Kg/m 2. Results: BMI is significantly associated with POC rate. POC rate decreased with increasing BMI below the inflection point of 30 Kg/m 2 (0.848[0.756, 0.952]) (OR [95% CI], p = 0.005). POC rate was found to increase with increasing BMI above the BMI inflection of 30 Kg/m 2 (1.102 [1.027, 1.182], p = 0.0071). Conclusions: In this cohort study, BMI showed an association with PC. It may be important to take BMI into account in surgical and clinical management considerations of RPNx, since higher rates of POC are associated with patients who are underweight, morbidly obese, and even with normal BMI. Further research is required on larger cohorts of RPNx patients to provide better description of this phenomenon and elucidate the role of BMI in development of POC.

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“…Previous studies have not noted significant alterations in renal functional outcomes following MIPN in obese patients. [8][9][10]22 However, these studies report short-term results ( £3 months postoperative) focusing on perioperative outcomes and feasibility of MIPN in obese patients, thus neglecting the potential for longer term renal functional consequences.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, BMI does seem to correlate with the amount of perinephric, visceral, and subcutaneous fat. 22 Finally, measurement of eGFR using the MDRD equation was initially developed for patients up to age 70 with CKD stage ‡3 and may lack the sensitivity to detect significant postoperative changes (it may not be as accurate in patients with GFR >60 or the obese). 25 The CKD Epidemiology Collaboration (CKD-EPI) equation has been developed to obviate some of these concerns and has shown increased accuracy especially for patients with eGFR >60 mL/minute/1.73 m 2 .…”

Section: Discussionmentioning

confidence: 99%

The Impact of Body Mass Index on Renal Functional Outcomes Following Minimally Invasive Partial Nephrectomy

Richards

Negron

Cohn

et al. 2014

Journal of Endourology

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Objective: To assess the impact of body mass index (BMI) on perioperative and renal functional outcomes in patients undergoing minimally invasive partial nephrectomy (MIPN). 19, 45). There were no differences in demographic, perioperative, or pathologic features between BMI groups. While controlling for gender, race, Charlson comorbidity score, tumor size, and ischemia time, obese class 1 (odds ratio [OR] 4.68, p = 0.019), obese class ‡2 (OR 4.27, p = 0.033), and age (OR 1.06, p = 0.014) were associated with increased risk of CKD stage ‡3; however, higher baseline eGFR (OR 0.91, p < 0.001) was associated with a reduced risk of CKD stage ‡3. While controlling for the same variables, increasing BMI was associated with a significant absolute reduction in eGFR at 1 year (0.38 mL/minute/1.73 m 2 reduction in GFR per 1 kg/m 2 increase in BMI, p = 0.009). Conclusions: MIPN is technically feasible in obese patients with similar perioperative outcomes to nonobese patients. BMI is an independent risk factor for worsening kidney function following MIPN.

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Effect of Visceral Obesity on Minimally Invasive Partial Nephrectomy

Cited by 28 publications

References 12 publications

Prospective assessment and histological analysis of adherent perinephric fat in partial nephrectomies

Prospective assessment and histological analysis of adherent perinephric fat in partial nephrectomies

The BMI Paradox and Robotic Assisted Partial Nephrectomy

The Impact of Body Mass Index on Renal Functional Outcomes Following Minimally Invasive Partial Nephrectomy

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