Vascularized Parenchymal Mass Preserved with Partial Nephrectomy: Functional Impact and Predictive Factors

Area of Science:

• Nephrology
• Urologic Oncology
• Surgical Outcomes

Background:

• Percentage parenchymal mass preserved (PPMP) is crucial for functional outcomes after partial nephrectomy (PN).
• Predictors of PPMP have not been well-defined.
• Understanding PPMP is key to optimizing kidney function post-PN.

Purpose of the Study:

• To comprehensively analyze the functional impact of PPMP after PN.
• To identify potential predictive factors for PPMP.
• To correlate PPMP with kidney function recovery.

Main Methods:

• Retrospective analysis of 464 patients undergoing PN.
• Measurement of PPMP using CT scans pre- and post-surgery.
• Correlation and multivariable logistic regression to assess predictors of PPMP and functional outcomes.

Main Results:

• Median PPMP was 84%, with 34% of patients experiencing suboptimal PPMP (<80%).
• GFR preservation strongly correlated with PPMP (r=0.64, p<0.001).
• Larger tumors, greater complexity, and longer ischemia time were associated with lower PPMP; solitary kidneys and hypothermia with higher PPMP.

Conclusions:

• Lower PPMP is the primary driver of functional decline post-PN.
• Tumor size, complexity, and ischemia time are key factors influencing PPMP.
• PPMP is a modifiable factor, with strategies like hypothermia potentially improving preservation, especially in solitary kidneys.