Profiling the Kidney Before the Incision: CT-Derived Signatures Steering Reconstructive Strategy After Off-Clamp...

Area of Science:

• Urology
• Surgical Oncology
• Radiology

Background:

• Minimally invasive, off-clamp partial nephrectomy (ocMIPN) requires careful reconstruction for optimal functional outcomes.
• Traditional nephrometry scores do not guide the choice between renorrhaphy and sutureless repair techniques.
• Identifying predictive preoperative parameters is crucial for tailoring ocMIPN reconstructive strategies.

Purpose of the Study:

• To identify preoperative CT-derived parameters predicting the need for renorrhaphy versus sutureless reconstruction in ocMIPN.
• To compare perioperative and functional outcomes between renorrhaphy and sutureless repair techniques in ocMIPN.

Main Methods:

• Retrospective analysis of 201 ocMIPN cases across two institutions using standardized off-clamp techniques.
• Central review of preoperative CT scans to quantify morphometric features: contact surface area (CSA), tumor radius, and Gerota's fascia thickness.
• Logistic regression models (radiologic variables only, and expanded with RENAL score) to identify predictors; comparison of perioperative and functional outcomes.

Main Results:

• Of 201 patients, 101 (50.2%) had sutureless reconstruction and 100 (49.8%) had renorrhaphy.
• Multivariable analysis identified CSA > 15 cm² and increased tumor radius as predictors for renorrhaphy.
• Integration of radiologic markers with the RENAL score improved predictive performance (AUC 0.81); perioperative and functional outcomes were similar between groups.

Conclusions:

• CT-derived morphologic markers (CSA, tumor radius, fascia thickness) can predict reconstructive strategy in ocMIPN.
• These markers augment the discriminatory power of the RENAL nephrometry score for surgical planning.
• Sutureless repair is a viable option in favorable anatomy, showing no significant difference in safety or renal function compared to renorrhaphy.