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Excised Parenchymal Mass During Partial Nephrectomy: Functional Implications

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机构: [1]Cleveland Clin, Glickman Urol & Kidney Inst, Cleveland, OH 44106 USA; [2]Sun Yat Sen Univ, Sun Yat Sen Mem Hosp, Guangdong Prov Key Lab Malignant Tumor Epigenet &, Dept Urol, Guangzhou, Guangdong, Peoples R China; [3]Sun Yat Sen Univ, State Key Lab Oncol South China, Collaborat Innovat Ctr Canc Med, Dept Urol,Canc Ctr, Guangzhou, Guangdong, Peoples R China; [4]Shanghai Jiao Tong Univ, Sch Med, Dept Urol, Ruijin Hosp, Shanghai, Peoples R China; [5]Yantai Yuhuangding Hosp, Dept Urol, Yantai, Shandong, Peoples R China; [6]Mahidol Univ, Siriraj Hosp, Div Urol, Dept Surg, Bangkok, Thailand; [7]Cleveland Clin, Imaging Inst, Cleveland, OH 44106 USA; [8]Cleveland Clin, Dept Quantitat Hlth Sci, Cleveland, OH 44106 USA; [9]Cleveland Clin, Ctr Urol Oncol, Glickman Urol & Kidney Inst, Room Q10-120,9500 Euclid Ave, Cleveland, OH 44195 USA
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OBJECTIVE To evaluate whether excised parenchymal mass (EPM) during partial nephrectomy (PN) correlates with functional decline and can serve as a surrogate for functional outcomes. MATERIALS AND METHODS All 215 patients managed with PN for unifocal renal mass with necessary studies to determine EPM and percent glomerular filtration rate (GFR) and parenchymal mass preserved (both global and specific to the operated kidney) were analyzed. EPM was estimated from the pathologic specimen by subtracting the tumor mass from the specimen mass, with both calculated using the elliptical formula. Vascularized parenchymal mass preserved was measured from computed tomography scans obtained <2 months prior and 3-12 months after surgery. All functional analyses were required to be within the same time frames, and patients with a contralateral kidney were also required to have nuclear renal scans. RESULTS The median tumor size was 3.5 cm and the median R.E.N.A.L. was 7. Warm and cold ischemia were utilized in 123 and 92 patients, respectively (median ischemia time = 23 minutes). The median global GFR preserved was 89%, the median total parenchymal mass preserved was 93%, and the median estimated EPM was 16 cm(3). Whereas percent parenchymal mass preserved correlated strongly with global and ipsilateral GFR preserved (both P < .001), EPM failed to correlate with functional outcomes on both univariable and multivariable analyses. CONCLUSION Our data suggest that parenchymal mass preserved with standard PN by experienced surgeons associates strongly with function preserved, whereas EPM fails to correlate with functional outcomes. Further study of the functional impact of EPM in other circumstances will be required, such as enucleation or PN performed by less-experienced surgeons. (C) 2016 Elsevier Inc.

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出版当年[2017]版:
大类 | 3 区 医学
小类 | 3 区 泌尿学与肾脏学
最新[2023]版:
大类 | 3 区 医学
小类 | 3 区 泌尿学与肾脏学
第一作者:
第一作者机构: [1]Cleveland Clin, Glickman Urol & Kidney Inst, Cleveland, OH 44106 USA; [2]Sun Yat Sen Univ, Sun Yat Sen Mem Hosp, Guangdong Prov Key Lab Malignant Tumor Epigenet &, Dept Urol, Guangzhou, Guangdong, Peoples R China; [3]Sun Yat Sen Univ, State Key Lab Oncol South China, Collaborat Innovat Ctr Canc Med, Dept Urol,Canc Ctr, Guangzhou, Guangdong, Peoples R China; [4]Shanghai Jiao Tong Univ, Sch Med, Dept Urol, Ruijin Hosp, Shanghai, Peoples R China; [5]Yantai Yuhuangding Hosp, Dept Urol, Yantai, Shandong, Peoples R China; [6]Mahidol Univ, Siriraj Hosp, Div Urol, Dept Surg, Bangkok, Thailand; [7]Cleveland Clin, Imaging Inst, Cleveland, OH 44106 USA; [8]Cleveland Clin, Dept Quantitat Hlth Sci, Cleveland, OH 44106 USA; [9]Cleveland Clin, Ctr Urol Oncol, Glickman Urol & Kidney Inst, Room Q10-120,9500 Euclid Ave, Cleveland, OH 44195 USA
通讯作者:
通讯机构: [1]Cleveland Clin, Glickman Urol & Kidney Inst, Cleveland, OH 44106 USA; [2]Sun Yat Sen Univ, Sun Yat Sen Mem Hosp, Guangdong Prov Key Lab Malignant Tumor Epigenet &, Dept Urol, Guangzhou, Guangdong, Peoples R China; [3]Sun Yat Sen Univ, State Key Lab Oncol South China, Collaborat Innovat Ctr Canc Med, Dept Urol,Canc Ctr, Guangzhou, Guangdong, Peoples R China; [4]Shanghai Jiao Tong Univ, Sch Med, Dept Urol, Ruijin Hosp, Shanghai, Peoples R China; [5]Yantai Yuhuangding Hosp, Dept Urol, Yantai, Shandong, Peoples R China; [6]Mahidol Univ, Siriraj Hosp, Div Urol, Dept Surg, Bangkok, Thailand; [7]Cleveland Clin, Imaging Inst, Cleveland, OH 44106 USA; [8]Cleveland Clin, Dept Quantitat Hlth Sci, Cleveland, OH 44106 USA; [9]Cleveland Clin, Ctr Urol Oncol, Glickman Urol & Kidney Inst, Room Q10-120,9500 Euclid Ave, Cleveland, OH 44195 USA
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