Category: Laparoscopic/ Robotic: Other

MP25-7 - Role of Androgen, Estrogen, and Progesterone Receptors in Adherent Perinephric Fat

Sun, Sep 23
10:00 AM - 12:00 PM

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.


Methods :

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.


Results :

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).


Conclusions :

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 M. Potretzke

Senior Associate Consultant
Department of Urology, Mayo Clinic, Rochester, MN
Rochester, Minnesota

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.

Rehan Rais

Resident
Washington University in St. Louis
Saint Louis, Missouri

Jalal Jalaly

Fellow
University of Pennsylvania
Philadelphia, Pennsylvania

Eric H. Kim

Assistant Professor
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.

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