Category: Laparoscopic/ Robotic: Other
Introduction & Objective :
Adherent perinephric fat (APF) has been recognized as a significant obstacle to partial nephrectomy. We sought to determine whether androgen, estrogen, and/or progesterone signaling play a role in the pathophysiology of adherent perinephric fat.
After IRB approval, we prospectively recruited patients undergoing robotic assisted partial nephrectomy by a single high-volume surgeon from 2015 to 2017. The operating surgeon documented the presence or absence of adherent perinephric fat. For those with clear cell renal cell carcinoma, representative tumor sections and associated perinephric fat were immunohistochemically stained with monoclonal antibody to estrogen, progesterone, and androgen receptors. Patient characteristics, operative data, and hormone receptor presence were compared between those with adherent and non-adherent perinephric fat with univariate analysis.
Of the fifty patients recruited for the study, thirty-one had clear cell renal cell carcinoma and completed hormone receptor staining. Thirteen (41.9%) patients had adherent perinephric fat, while 18 (58.1%) were classified as non-adherent. Adherent perinephric fat was not associated with any baseline patient characteristics, including age, BMI, Charleston comorbidity index, smoking status, or preoperative estimated glomerular filtration rate. Patients with larger tumors tend to have APF (4.0 cm vs 2.8 cm, p = 0.022). Although APF predicted higher estimated blood loss (263.3 mL vs 181.6 mL, p = 0.044), it was not significantly associated with length of operation, positive margins, or 30-day postoperative complications. The majority of tumors and perinephric fat were negative for estrogen and progesterone while positive for androgen receptor expression. There was no difference in hormone receptor expression in either tumor or perinephric fat when classified by presence or absence of APF (Table 1).
Adherent perinephric fat may be more commonly present in larger tumors and correlates with increased blood loss during robotic assisted partial nephrectomy. However, it does not appear to be associated with differential sex hormone receptor expression in clear cell renal cell carcinoma.
Kefu Du– Fellow, Washington University in St. Louis, Saint Louis, Missouri
Aaron Potretzke– Senior Associate Consultant, Department of Urology, Mayo Clinic, Rochester, MN, Rochester, Minnesota
Rehan Rais– Resident, Washington University in St. Louis, Saint Louis, Missouri
Jalal Jalaly– Fellow, University of Pennsylvania, Philadelphia, Pennsylvania
Eric Kim– Assistant Professor, Washington University in St. Louis, St. Louis, Missouri
Christopher Han– Fellow, Washington University in St. Louis, Saint Louis, Missouri
Barrett Anderson– Clinical Assistant Professor, Michigan State University / Detroit Medical Center, Detroit, Michigan
Justin Benabdallah– Assistant Professor, Johns Hopkins University, Baltimore, Maryland
Joel Vetter– Statistician, Washington University in St. Louis, Saint Louis, Missouri
Alethea Paradis– Research manager, Washington University in St. Louis, Saint Louis, Missouri
Ramakrishna Venkatesh– Professor, Washington University in St. Louis, Saint Louis, Missouri
Robert Figenshau– Professor, Washington University in St. Louis, Saint Louis, Missouri
Senior Associate Consultant
Department of Urology, Mayo Clinic, Rochester, MN
Aaron Mark Potretzke, MD is an assistant professor and senior associate consultant at the Mayo Clinic in Rochester, MN. He completed residency at the University of Wisconsin in Madison, WI and a two-year fellowship in Minimally Invasive Urologic Surgery and Endourology at Washington University in St. Louis, MO. His clinical interests include minimally invasive management of renal and upper tract urothelial cancer, as well as upper urinary tract obstructive disease and urolithiasis. His research focuses on renal and upper tract urothelial cancer.
Washington University in St. Louis
St. Louis, Missouri
Eric H. Kim, M.D., is an Assistant Professor of Surgery in the Division of Urologic Surgery at Washington University School of Medicine in St. Louis. Clinically, he specializes in robotic surgery for urologic cancers. His research focuses on imaging in prostate cancer.
Clinical Assistant Professor
Michigan State University / Detroit Medical Center
Washington University in St. Louis
Saint Louis, Missouri