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

Abstract：

INTRODUCTION:Adherent perirenal fat (APF) can be defined as inflammatory fat sticking to renal parenchyma, whose dissection is difficult and makes it troublesome to expose the tumour. Our objective was to evaluate the impact of APF on the technical difficulty of robot-assisted partial nephrectomy (RPN). PATIENTS AND METHODS:We analysed data of 202 patients who underwent RPN for a small renal tumour. Patients were divided into two groups according to the presence of APF. Peri-operative data were compared between the two groups. Predictors of APF were evaluated by univariate and multivariate analysis. The validity of the MAP score (radiological scoring system) was also assessed. RESULTS:APF was observed in 80 patients (39.6 %). Tumour complexity and surgeon's experience were similar between both groups. Operative time was 40 min longer in the APF group (188.5 vs. 147.9 min, p < 0.0001). Blood loss was twice higher, and transfusions were more common in the APF group (694 vs. 330 ml, p < 0.0001 and 19 vs. 5.8 %, p = 0.003, respectively). APF was associated with an increased risk of conversion to open surgery (11.2 vs. 0 %, p = 0.0002) or radical nephrectomy (6.2 vs. 0.8 %, p = 0.03). In multivariate analysis, male gender (OR 13.2, p < 0.0001), obesity (OR 1.2, p = 0.007), hypertension (OR 3.7, p = 0.02), and MAP score (OR 3.3; p < 0.0001) were significant predictors of APF. CONCLUSION: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.

journal_name

World J Urol

journal_title

World journal of urology

authors

Khene ZE,Peyronnet B,Mathieu R,Fardoun T,Verhoest G,Bensalah K

doi

10.1007/s00345-015-1500-0

subject

Has Abstract

pub_date

2015-11-01 00:00:00

pages

1801-6

issue

11

eissn

0724-4983

issn

1433-8726

pii

10.1007/s00345-015-1500-0

journal_volume

33

pub_type

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