Residual Parenchymal Volume, Not Warm Ischemia Time, Predicts Ultimate Renal Functional Outcomes in Patients Undergoing Partial Nephrectomy

Serge Ginzburg; Robert Uzzo; John Walton; Christopher Miller; David Kurz; Tianyu Li; Elizabeth Handorf; Ronak Gor; Anthony Corcoran; Rosalia Viterbo; David Y.T. Chen; Richard E. Greenberg; Marc C. Smaldone; Alexander Kutikov

doi:10.1016/j.urology.2015.04.043

Residual Parenchymal Volume, Not Warm Ischemia Time, Predicts Ultimate Renal Functional Outcomes in Patients Undergoing Partial Nephrectomy

Serge Ginzburg, Robert Uzzo, John Walton, Christopher Miller, David Kurz, Tianyu Li, Elizabeth Handorf, Ronak Gor, Anthony Corcoran, Rosalia Viterbo, David Y.T. Chen, Richard E. Greenberg, Marc C. Smaldone, Alexander Kutikov

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Abstract

Objective To examine relative contributions of functional parenchymal preservation and renal ischemia following nephron-sparing surgery (NSS). While residual functional parenchymal volume (FPV) is proposed as the key factor in predicting functional outcomes following NSS, efforts to curtail ischemia time continue to add technical complexity to partial nephrectomy. Methods Our kidney cancer database was queried for patients who underwent NSS with warm ischemia time (WIT). Patients with cross-sectional imaging for FPV calculation were included. Cylindrical volume approximation methodology was used to calculate FPV, accounting for the volume of tumor's endophytic component. Percent estimated glomerular filtration rate (eGFR) preservation, perioperatively and at 6 months, was the outcome metric. Spearman correlation and linear regression analyses were used to evaluate associations of WIT and %FPV preservation with renal function preservation. Results Of the 179 patients included, median preoperative eGFR was 88.4 (9.5% chronic kidney disease III or IV), tumor size was 2.7 cm (interquartile range [IQR] 2.0-3.6 cm), and R.E.N.A.L. nephrometry was low in 34%, intermediate in 57%, and high in 9%. Median WIT was 30 minutes (IQR 24-36), resulting in 97.4% FPV preservation. Median postoperative eGFR at 6.4 months was 80.5 (19.1% chronic kidney disease III or IV), a median of 93.1% eGFR preservation (IQR 85.1-101.7). At discharge, WIT (P <.001), not %FPV (P =.112), was associated with %eGFR preservation. However, 6 months following surgery, on multivariable analysis, both preoperative eGFR (linear regression coefficient = -0.208, P =.006) and %FPV preservation (linear regression coefficient = 0.491, P =.001), but not WIT (P =.946), demonstrated statistically significant association with %eGFR preservation. Conclusion Residual FPV, and not WIT, appears to be the main predictor of ultimate renal function following NSS.

Original language	English (US)
Pages (from-to)	300-306
Number of pages	7
Journal	Urology
Volume	86
Issue number	2
DOIs	https://doi.org/10.1016/j.urology.2015.04.043
State	Published - Aug 1 2015
Externally published	Yes

Bibliographical note

Funding Information:
Funding Support: This publication was supported in part by grant number P30 CA006927 from the National Cancer Institute and by the Department of Defense, Physician Research Training Award (AK). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute, the National Institutes of Health, nor the Department of Defense. Additional funds were provided by Fox Chase Cancer via institutional support of the Kidney Cancer Keystone Program.

Publisher Copyright:
© 2015 Elsevier Inc.

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Ginzburg, S., Uzzo, R., Walton, J., Miller, C., Kurz, D., Li, T., Handorf, E., Gor, R., Corcoran, A., Viterbo, R., Chen, D. Y. T., Greenberg, R. E., Smaldone, M. C., & Kutikov, A. (2015). Residual Parenchymal Volume, Not Warm Ischemia Time, Predicts Ultimate Renal Functional Outcomes in Patients Undergoing Partial Nephrectomy. Urology, 86(2), 300-306. https://doi.org/10.1016/j.urology.2015.04.043

Ginzburg, S, Uzzo, R, Walton, J, Miller, C, Kurz, D, Li, T, Handorf, E, Gor, R, Corcoran, A, Viterbo, R, Chen, DYT, Greenberg, RE, Smaldone, MC & Kutikov, A 2015, 'Residual Parenchymal Volume, Not Warm Ischemia Time, Predicts Ultimate Renal Functional Outcomes in Patients Undergoing Partial Nephrectomy', Urology, vol. 86, no. 2, pp. 300-306. https://doi.org/10.1016/j.urology.2015.04.043

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title = "Residual Parenchymal Volume, Not Warm Ischemia Time, Predicts Ultimate Renal Functional Outcomes in Patients Undergoing Partial Nephrectomy",

abstract = "Objective To examine relative contributions of functional parenchymal preservation and renal ischemia following nephron-sparing surgery (NSS). While residual functional parenchymal volume (FPV) is proposed as the key factor in predicting functional outcomes following NSS, efforts to curtail ischemia time continue to add technical complexity to partial nephrectomy. Methods Our kidney cancer database was queried for patients who underwent NSS with warm ischemia time (WIT). Patients with cross-sectional imaging for FPV calculation were included. Cylindrical volume approximation methodology was used to calculate FPV, accounting for the volume of tumor's endophytic component. Percent estimated glomerular filtration rate (eGFR) preservation, perioperatively and at 6 months, was the outcome metric. Spearman correlation and linear regression analyses were used to evaluate associations of WIT and %FPV preservation with renal function preservation. Results Of the 179 patients included, median preoperative eGFR was 88.4 (9.5% chronic kidney disease III or IV), tumor size was 2.7 cm (interquartile range [IQR] 2.0-3.6 cm), and R.E.N.A.L. nephrometry was low in 34%, intermediate in 57%, and high in 9%. Median WIT was 30 minutes (IQR 24-36), resulting in 97.4% FPV preservation. Median postoperative eGFR at 6.4 months was 80.5 (19.1% chronic kidney disease III or IV), a median of 93.1% eGFR preservation (IQR 85.1-101.7). At discharge, WIT (P <.001), not %FPV (P =.112), was associated with %eGFR preservation. However, 6 months following surgery, on multivariable analysis, both preoperative eGFR (linear regression coefficient = -0.208, P =.006) and %FPV preservation (linear regression coefficient = 0.491, P =.001), but not WIT (P =.946), demonstrated statistically significant association with %eGFR preservation. Conclusion Residual FPV, and not WIT, appears to be the main predictor of ultimate renal function following NSS.",

author = "Serge Ginzburg and Robert Uzzo and John Walton and Christopher Miller and David Kurz and Tianyu Li and Elizabeth Handorf and Ronak Gor and Anthony Corcoran and Rosalia Viterbo and Chen, {David Y.T.} and Greenberg, {Richard E.} and Smaldone, {Marc C.} and Alexander Kutikov",

note = "Funding Information: Funding Support: This publication was supported in part by grant number P30 CA006927 from the National Cancer Institute and by the Department of Defense, Physician Research Training Award (AK). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute, the National Institutes of Health, nor the Department of Defense. Additional funds were provided by Fox Chase Cancer via institutional support of the Kidney Cancer Keystone Program. Publisher Copyright: {\textcopyright} 2015 Elsevier Inc.",

year = "2015",

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doi = "10.1016/j.urology.2015.04.043",

language = "English (US)",

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T1 - Residual Parenchymal Volume, Not Warm Ischemia Time, Predicts Ultimate Renal Functional Outcomes in Patients Undergoing Partial Nephrectomy

AU - Ginzburg, Serge

AU - Uzzo, Robert

AU - Walton, John

AU - Miller, Christopher

AU - Kurz, David

AU - Li, Tianyu

AU - Handorf, Elizabeth

AU - Gor, Ronak

AU - Corcoran, Anthony

AU - Viterbo, Rosalia

AU - Chen, David Y.T.

AU - Greenberg, Richard E.

AU - Smaldone, Marc C.

AU - Kutikov, Alexander

N1 - Funding Information: Funding Support: This publication was supported in part by grant number P30 CA006927 from the National Cancer Institute and by the Department of Defense, Physician Research Training Award (AK). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute, the National Institutes of Health, nor the Department of Defense. Additional funds were provided by Fox Chase Cancer via institutional support of the Kidney Cancer Keystone Program. Publisher Copyright: © 2015 Elsevier Inc.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Objective To examine relative contributions of functional parenchymal preservation and renal ischemia following nephron-sparing surgery (NSS). While residual functional parenchymal volume (FPV) is proposed as the key factor in predicting functional outcomes following NSS, efforts to curtail ischemia time continue to add technical complexity to partial nephrectomy. Methods Our kidney cancer database was queried for patients who underwent NSS with warm ischemia time (WIT). Patients with cross-sectional imaging for FPV calculation were included. Cylindrical volume approximation methodology was used to calculate FPV, accounting for the volume of tumor's endophytic component. Percent estimated glomerular filtration rate (eGFR) preservation, perioperatively and at 6 months, was the outcome metric. Spearman correlation and linear regression analyses were used to evaluate associations of WIT and %FPV preservation with renal function preservation. Results Of the 179 patients included, median preoperative eGFR was 88.4 (9.5% chronic kidney disease III or IV), tumor size was 2.7 cm (interquartile range [IQR] 2.0-3.6 cm), and R.E.N.A.L. nephrometry was low in 34%, intermediate in 57%, and high in 9%. Median WIT was 30 minutes (IQR 24-36), resulting in 97.4% FPV preservation. Median postoperative eGFR at 6.4 months was 80.5 (19.1% chronic kidney disease III or IV), a median of 93.1% eGFR preservation (IQR 85.1-101.7). At discharge, WIT (P <.001), not %FPV (P =.112), was associated with %eGFR preservation. However, 6 months following surgery, on multivariable analysis, both preoperative eGFR (linear regression coefficient = -0.208, P =.006) and %FPV preservation (linear regression coefficient = 0.491, P =.001), but not WIT (P =.946), demonstrated statistically significant association with %eGFR preservation. Conclusion Residual FPV, and not WIT, appears to be the main predictor of ultimate renal function following NSS.

AB - Objective To examine relative contributions of functional parenchymal preservation and renal ischemia following nephron-sparing surgery (NSS). While residual functional parenchymal volume (FPV) is proposed as the key factor in predicting functional outcomes following NSS, efforts to curtail ischemia time continue to add technical complexity to partial nephrectomy. Methods Our kidney cancer database was queried for patients who underwent NSS with warm ischemia time (WIT). Patients with cross-sectional imaging for FPV calculation were included. Cylindrical volume approximation methodology was used to calculate FPV, accounting for the volume of tumor's endophytic component. Percent estimated glomerular filtration rate (eGFR) preservation, perioperatively and at 6 months, was the outcome metric. Spearman correlation and linear regression analyses were used to evaluate associations of WIT and %FPV preservation with renal function preservation. Results Of the 179 patients included, median preoperative eGFR was 88.4 (9.5% chronic kidney disease III or IV), tumor size was 2.7 cm (interquartile range [IQR] 2.0-3.6 cm), and R.E.N.A.L. nephrometry was low in 34%, intermediate in 57%, and high in 9%. Median WIT was 30 minutes (IQR 24-36), resulting in 97.4% FPV preservation. Median postoperative eGFR at 6.4 months was 80.5 (19.1% chronic kidney disease III or IV), a median of 93.1% eGFR preservation (IQR 85.1-101.7). At discharge, WIT (P <.001), not %FPV (P =.112), was associated with %eGFR preservation. However, 6 months following surgery, on multivariable analysis, both preoperative eGFR (linear regression coefficient = -0.208, P =.006) and %FPV preservation (linear regression coefficient = 0.491, P =.001), but not WIT (P =.946), demonstrated statistically significant association with %eGFR preservation. Conclusion Residual FPV, and not WIT, appears to be the main predictor of ultimate renal function following NSS.

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Residual Parenchymal Volume, Not Warm Ischemia Time, Predicts Ultimate Renal Functional Outcomes in Patients Undergoing Partial Nephrectomy

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