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

Abstract

APF can be accurately predicted using radioclinical data as the MAP score, combined with sex, age, and waist circumference. APF is associated with increased operative time and blood loss without postoperative complications. Histological analysis finds larger adipocytes in APF without inflammatory infiltrate, and no difference in fibrosis.

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

“…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].…”

“…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.…”

“…As we demonstrated that systemic inflammation as indicated by the elevation of C-reactive protein is a significant factor for renal cell carcinoma prognosis [16], Thiel et al [17] demonstrated that higher MAP scores were associated with decreased progression- free survival for localized renal cell carcinoma. However, Dariane et al [4] reported that, histologically, there were larger adipocytes in APF tissue but no histological differences in inflammatory infiltrate and fibrosis. Therefore, the association between APF and inflammation as well as its relevance to PN remains to be proven.…”

“…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.…”

“…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].…”