Category: Clinical Oncology: Outcomes & Complications

MP18-3 - Volumetric Changes of The Operated and Contralateral Kidney After Partial Nephrectomy and Its' Association with Functional Outcome Using A 3D Tissue Segmentation Analysis

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective : Recent studies point to the importance of kidney volume in predicting functional outcome post-partial nephrectomy (PN). However, there is limited evidence regarding compensatory hypertrophy of the contralateral kidney. We sought to evaluate the renal volume change over time and its' effect on estimated glomerular filtration rate (eGFR) on both the operated and contralateral kidney.


Methods : From our institutional database, 49 robotic partial nephrectomy (RPN) patients with complete data on eGFR, functional kidney volume of both kidneys at preoperative, and at six months postoperative (Window: 3-9 months) period were used. To calculate the functional kidney volume, tumor volume and cyst volumes (>1 cm) were subtracted from the overall kidney volume. Kidney volumes were obtained using a tissue segmentation software (Vitrea®, version 6.7, Vital Images, Inc., Minneapolis, MN, USA) The association between clinical and tumor-specific factors with contralateral hypertrophy after RPN was evaluated. Change in operated and contralateral kidney volume and eGFR at six months was also analyzed. All analyses were performed using univariable and multivariable linear mixed effects models adjusting for patient factors and warm ischemia time.


Results : There was a significant decline in functional volume of the operated kidney (D= -33.8 mL, p<0.001) and a significant increase in volume of the contralateral kidney (p<0.001) (Figure 1) at six-month follow up. Younger age (p=0.004) was associated with greater contralateral hypertrophy; however, eGFR (p=.342), tumor size (p=.907), and the decline in functional operated kidney volume (p=0.369) were not significant. In multivariable analysis, only the the decrease in operated kidney volume (p=0.049) was associated with eGFR decline, while ischemia time (p=0.202) and contralateral hypertrophy (p=0.826) were not at six-month follow up.


Conclusions : While a decrease in the operated kidney volume was associated with decline in eGFR, the hypertrophy of the contralateral kidney did not correlate with functional outcome. This may be due to short-term follow up for eGFR. Larger prospective studies are required to determine the role of compensatory hypertrophy during partial nephrectomy.

Alp Tuna Beksac

Fellow
Icahn School of Medicine at Mount Sinai
New York, New York

Endourological Society Fellow in Minimally Invasive and Robotic Surgery at Icahn School of Medicine at Mount Sinai.

Qainat Shah

Researcher
Icahn School of Medicine at Mount Sinai
New York, New York

David Paulucci

Fellow
Icahn School of Medicine at Mount Sinai
New York, New York

Sara C. Lewis

Assistant Professor of Radiology
Icahn School of Medicine at Mount Sinai
New York, New York

Bachir Taouli

Professor of Radiology
Icahn School of Medicine at Mount Sinai
New York, New York

Ketan Badani

Professor of Urology
Icahn School of Medicine at Mount Sinai
New York, New York