Objective: To assess the usefulness of tumor-centered multiplanar reconstruction (TC-MPR) for predicting intraoperative urinary collecting system (UCS) entry in patients with peripheral renal tumors undergoing partial nephrectomy (PN). Methods: Dynamic computed tomography images of 50 peripheral cT1 renal tumors treated with laparoendoscopic PN were analyzed. TC-MPR generated a digital cross-sectional image showing the tumor center and the closest calyx on a same plane. Patients and tumor characteristics including the distance from the tumor margin to the closest calyx (MPR-distance), and the angle formed by 2 tangent lines from the closest calyx to the tumor (MPR-angle) were assessed. Results: Intraoperative UCS entry was observed in 15 patients (30%). The patients who experienced intraoperative UCS entry had a higher RENAL score, wider MPR-angle, and shorter MPR-distance than those who did not (p = 0.04, p = 0.001, p < 0.001, respectively). Multivariate analysis identified MPR-angle as an independent factor for intraoperative UCS entry (p < 0.001). Conclusions: The spatial information assessed using TC-MPR serves as a predictive factor for intraoperative UCS entry during PN.

Keywords:
Nephrectomy, Kidney neoplasm, Intraoperative complications, Multidetector computed tomography, Image processing, Computer-assisted
1.
Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Marechal JM, Klotz L, Skinner E, Keane T, Claessens I, Sylvester R: A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2007; 51: 1606–1615.
2.
Meyer C, Hansen J, Becker A, Schmid M, Pradel L, Strini K, Chromecki T, Jesche-Chromechi J, Fisch M, Zigeuner R, Chun FK: The Adoption of nephron-sparing surgery in -Europe – a trend analysis in two referral centers from Austria and Germany. Urol Int 2016; 96: 330–336.
3.
Dong D, Ji Z, LI H, Yan W, Zhang Y: Laparoscopic nephron sparing surgery assisted with laparoscopic ultrasonography on centrally located renal tumor - single center experience. Urol Int 2016; 97: 195–199.
4.
Ficarra V, Bhayani S, Porter J, Buffi N, Lee R, Cestari A, Mottrie A: Predictors of warm ischemia time and perioperative complications in a multicenter, international series of robot-assisted partial nephrectomy. Eur Urol 2012; 61: 395–402.
5.
Tamaszewski JJ, Cung B, Smaldone MC, Meharazin R, Kutikov A, Viterbo R, Chen D, Greenberg RE, Uzzo RG: Renal pelvic anatomy is associated with incidence, grade, and need for intervention for urine leak following partial nephrectomy. Eur Urol 2014; 66: 949–955.
6.
Kundu SD, Thompson RH, Kallingal GJ, Cambareri G, Russo P: Urinary fistulae after partial nephrectomy. BJU Int 2010; 106: 1042–1044.
7.
Meeks JJ, Zhao LC, Navai N, Perry KT Jr, Nadler RB, Smith ND: Risk factors and management of urine leaks after partial nephrectomy. J Urol 2008; 180: 2375–2378.
8.
Ficcara V, Novara G, Secco S, Macchi V, Porzionato A, De Caro R, Artibani W: Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumors in patients who are candidates for nephron-sparing surgery. Eur Urol 2009; 56: 786–793.
9.
Kutikov A, Uzzo RG: The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 2009; 182: 844–853.
10.
Simmons MN, Ching CB, Samplaski MK, Park CH, Gill IS: Kidney tumor location measurement using the C-index method. J Urol 2010; 183: 1708–1713.
11.
Bruner B, Breau RH, Lohse CM, Leibovich BC, Blute ML: Renal nephrometry score is associated with urine leak after partial nephrectomy. BJU Int 2011; 108: 67–72.
12.
Stroup SP, Palazzi K, Kopp RP, Mehrazin R, Santomauro M, Cohen SA, Patterson AL, L’Esperance JO, Derweesh IH: RENAL nephrometry score is associated with operative approach for partial nephrectomy and urine leak. Urology 2012; 80: 151–156.
13.
Mayer WA, Godoy G, Choi JM, Goh AC, Bian SX, Link RE: Higher RENAL nephrometry score is predictive of longer warm ischemia time and collecting system entry during laparoscopic and robotic-assisted partial nephrectomy. Urology 2012; 79: 1052–1056.
14.
Kihara K, Koga F, Fujii Y, Masuda H, Tatokoro M, Yokoyama M, Matsuoka Y, Numao N, Ishioka J, Saito K: Gasless laparoendoscopic single-port clampless sutureless partial nephrectomy for peripheral renal tumors: perioperative outcomes. Int J Urol 2015; 22: 349–355.
15.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240: 205–213.
16.
Singh D, Gill IS: Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. J Urol 2005; 174: 2256–2259.
17.
Hyams ES, Pierorazio P, Proteek O, Sukumar S, Wagner AA, Mechaber JL, Rogers C, Kavoussi L, Allaf M: Iatrogenic vascular lesions after minimally invasive partial nephrectomy: a multi-institutional study of clinical and renal functional outcomes. Urology 2011; 78: 820–826.
18.
Simone G, Papalia R, Guaglianone S, Gallucci M: ‘Zero ischaemia’, sutureless laparoscopic partial nephrectomy for renal tumours with a low nephrometry score. BJU Int 2012; 110: 124–130.
19.
Ota T, Komori H, Rii J, Ochi A, Suzuki K, Shiga N, Nishiyama H: Soft coagulation in partial nephrectomy without renorrhaphy: feasibility of a new technique and early outcomes. Int J Urol 2014; 21: 244–247.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.