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Published on: November 23, 2017
Visceral fat is associated with high-grade complications in patients undergoing minimally invasive partial
Kelan Nesbitt1, Pranav Sharma1
1Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Introduction:
Minimally invasive partial nephrectomy is standard of care treatment for small renal masses.
Objective:
We evaluated the relationship between subcutaneous and visceral obesity with high-grade postoperative 30-day complications in patients undergoing minimally invasive partial nephrectomy.
Methods:
We retrospectively identified 98 patients at our institution from 2014 to 2017 who underwent laparoscopic or robotic-assisted partial nephrectomy due to suspected renal cell carcinoma. Patients were stratified based on presence or absence of high-grade (Clavien ≥ IIIa) 30-day postoperative complications. Means were compared with the independent t test and proportions with chi-square analysis. Multivariate logistic regression was performed to determine independent predictors of high-grade 30-day complications.
Results:
Mean nephrometry score was 6.7 with 21 (21.4%) patients having hilar tumors. Mean estimation of blood loss was 207 mL, mean operating time was 223 min, and mean warm ischemia time was 23 min. The majority of patients had clear renal cell carcinoma (n = 83, 84.7%) and pT1a disease (n = 76, 77.6%) with negative margins (n = 89, 90.8%) on pathology. There were 5 (5.1%) patients who experienced a high-grade postoperative 30-day complication. Mean visceral fat index was an independent predictor of high-grade 30-day complications (odds ratio: 1.02; 95% confidence interval: 1.002-1.03; p = 0.027).
Conclusions:
Visceral obesity should be considered as a prognostic indicator of outcomes in patients undergoing surgical treatment for a small renal mass.
Insights
Visceral obesity, a measure of abdominal fat, independently predicts high-grade complications after partial nephrectomy for small renal masses. This finding highlights the importance of considering visceral adiposity in surgical risk assessment.
Area of Science:
- Urology
- Surgical Oncology
- Obesity Medicine
Background:
- Minimally invasive partial nephrectomy is the standard treatment for small renal masses.
- Patient obesity is a growing concern in surgical outcomes.
Purpose of the Study:
- To evaluate the association between subcutaneous and visceral obesity and high-grade postoperative complications.
- To identify predictors of complications following minimally invasive partial nephrectomy.
Main Methods:
- Retrospective review of 98 patients undergoing laparoscopic or robotic-assisted partial nephrectomy (2014-2017).
- Stratification based on high-grade (Clavien ≥ IIIa) 30-day postoperative complications.
- Multivariate logistic regression analysis to determine independent predictors.
Main Results:
- 5.1% of patients experienced high-grade 30-day postoperative complications.
- Mean visceral fat index was an independent predictor of high-grade complications (OR: 1.02; 95% CI: 1.002-1.03; P=0.027).
- Tumor characteristics included mean nephrometry score of 6.7 and 84.7% clear cell renal cell carcinoma.
Conclusions:
- Visceral obesity is a significant prognostic indicator for outcomes in patients with small renal masses.
- Consideration of visceral fat may improve preoperative risk stratification and patient counseling.
