Differentiating reconstructive techniques in partial nephrectomy

A propensity score analysis

Clinton Bahler, K. Clinton Cary, Swapnil Garg, Eric M. DeRoo, Christian H. Tabib, Jagan K. Kansal, M. Francesca Monn, Chandra K. Flack, Timothy Masterson, M. Kumar Sandrasegaran, Richard Foster, Chandru Sundaram

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction: To assess whether volumetric measurements can differentiate functional changes between reconstructive techniques after partial nephrectomy. Materials and methods: One hundred and fifty-six patients undergoing partial nephrectomy for a single renal mass were retrospectively studied between 2008 and 2012. Computed tomography scans were available for volume calculations on 56 (18 non-renorrhaphy and 38 renorrhaphy). Institutional review board approval was obtained. The primary outcome was %volume loss in the operated kidney, which was calculated from three-dimensional reconstructions using a semiautomatic segmentation algorithm. Multivariable regression and propensity score analysis was performed. Results: Volumetric analysis detected a difference in mean %volume loss between two-layer reconstruction (cortical renorrhaphy and base-layer) and base-layer only (15.6% versus 3.8%, p <0.001). The mean %glomerular filtration rate (GFR) loss was also greater in the two-layer group (8.9% versus 2.4%, p = 0.03). Demographics were similar between groups except the two-layer group was older, had more males, and increased ischemia time. On multivariable regression the presence of two-layer closure (β = -15.2%, p <0.001) and tumor diameter (β = -7.4, p = 0.004) were significant predictors of %volume loss while ischemia time (p = 0.88) was not. Two-layer closure remained a predictor on propensity-adjusted analysis (β = -14.3, p = 0.004). The base-layer only group had two (5.3%) urine leaks and two (5.3%) bleeding complications. The two-layer group had two (1.7%) urine leaks and three (2.5%) bleeding complications (p = 0.23, 0.41). Conclusions: Volume loss calculated from CT scans can be used to monitor postoperative renal function. Techniques for renal reconstruction and tumor diameter are associated with volume and functional loss after partial nephrectomy and should be controlled for in future studies.

Original languageEnglish (US)
Pages (from-to)7788-7796
Number of pages9
JournalCanadian Journal of Urology
Volume22
Issue number3
StatePublished - 2015

Fingerprint

Propensity Score
Nephrectomy
Kidney
Ischemia
Urine
Hemorrhage
Research Ethics Committees
Glomerular Filtration Rate
Neoplasms
Tomography
Demography

Keywords

  • Carcinoma
  • Kidney function test
  • Partial nephrectomy
  • Renal cell
  • Robotics
  • Volumetric computed tomography

ASJC Scopus subject areas

  • Urology

Cite this

Differentiating reconstructive techniques in partial nephrectomy : A propensity score analysis. / Bahler, Clinton; Cary, K. Clinton; Garg, Swapnil; DeRoo, Eric M.; Tabib, Christian H.; Kansal, Jagan K.; Francesca Monn, M.; Flack, Chandra K.; Masterson, Timothy; Kumar Sandrasegaran, M.; Foster, Richard; Sundaram, Chandru.

In: Canadian Journal of Urology, Vol. 22, No. 3, 2015, p. 7788-7796.

Research output: Contribution to journalArticle

Bahler, C, Cary, KC, Garg, S, DeRoo, EM, Tabib, CH, Kansal, JK, Francesca Monn, M, Flack, CK, Masterson, T, Kumar Sandrasegaran, M, Foster, R & Sundaram, C 2015, 'Differentiating reconstructive techniques in partial nephrectomy: A propensity score analysis', Canadian Journal of Urology, vol. 22, no. 3, pp. 7788-7796.
Bahler, Clinton ; Cary, K. Clinton ; Garg, Swapnil ; DeRoo, Eric M. ; Tabib, Christian H. ; Kansal, Jagan K. ; Francesca Monn, M. ; Flack, Chandra K. ; Masterson, Timothy ; Kumar Sandrasegaran, M. ; Foster, Richard ; Sundaram, Chandru. / Differentiating reconstructive techniques in partial nephrectomy : A propensity score analysis. In: Canadian Journal of Urology. 2015 ; Vol. 22, No. 3. pp. 7788-7796.
@article{5de4a997448a47979f0066cd055a71e7,
title = "Differentiating reconstructive techniques in partial nephrectomy: A propensity score analysis",
abstract = "Introduction: To assess whether volumetric measurements can differentiate functional changes between reconstructive techniques after partial nephrectomy. Materials and methods: One hundred and fifty-six patients undergoing partial nephrectomy for a single renal mass were retrospectively studied between 2008 and 2012. Computed tomography scans were available for volume calculations on 56 (18 non-renorrhaphy and 38 renorrhaphy). Institutional review board approval was obtained. The primary outcome was {\%}volume loss in the operated kidney, which was calculated from three-dimensional reconstructions using a semiautomatic segmentation algorithm. Multivariable regression and propensity score analysis was performed. Results: Volumetric analysis detected a difference in mean {\%}volume loss between two-layer reconstruction (cortical renorrhaphy and base-layer) and base-layer only (15.6{\%} versus 3.8{\%}, p <0.001). The mean {\%}glomerular filtration rate (GFR) loss was also greater in the two-layer group (8.9{\%} versus 2.4{\%}, p = 0.03). Demographics were similar between groups except the two-layer group was older, had more males, and increased ischemia time. On multivariable regression the presence of two-layer closure (β = -15.2{\%}, p <0.001) and tumor diameter (β = -7.4, p = 0.004) were significant predictors of {\%}volume loss while ischemia time (p = 0.88) was not. Two-layer closure remained a predictor on propensity-adjusted analysis (β = -14.3, p = 0.004). The base-layer only group had two (5.3{\%}) urine leaks and two (5.3{\%}) bleeding complications. The two-layer group had two (1.7{\%}) urine leaks and three (2.5{\%}) bleeding complications (p = 0.23, 0.41). Conclusions: Volume loss calculated from CT scans can be used to monitor postoperative renal function. Techniques for renal reconstruction and tumor diameter are associated with volume and functional loss after partial nephrectomy and should be controlled for in future studies.",
keywords = "Carcinoma, Kidney function test, Partial nephrectomy, Renal cell, Robotics, Volumetric computed tomography",
author = "Clinton Bahler and Cary, {K. Clinton} and Swapnil Garg and DeRoo, {Eric M.} and Tabib, {Christian H.} and Kansal, {Jagan K.} and {Francesca Monn}, M. and Flack, {Chandra K.} and Timothy Masterson and {Kumar Sandrasegaran}, M. and Richard Foster and Chandru Sundaram",
year = "2015",
language = "English (US)",
volume = "22",
pages = "7788--7796",
journal = "Canadian Journal of Urology",
issn = "1195-9479",
publisher = "Canadian Journal of Urology",
number = "3",

}

TY - JOUR

T1 - Differentiating reconstructive techniques in partial nephrectomy

T2 - A propensity score analysis

AU - Bahler, Clinton

AU - Cary, K. Clinton

AU - Garg, Swapnil

AU - DeRoo, Eric M.

AU - Tabib, Christian H.

AU - Kansal, Jagan K.

AU - Francesca Monn, M.

AU - Flack, Chandra K.

AU - Masterson, Timothy

AU - Kumar Sandrasegaran, M.

AU - Foster, Richard

AU - Sundaram, Chandru

PY - 2015

Y1 - 2015

N2 - Introduction: To assess whether volumetric measurements can differentiate functional changes between reconstructive techniques after partial nephrectomy. Materials and methods: One hundred and fifty-six patients undergoing partial nephrectomy for a single renal mass were retrospectively studied between 2008 and 2012. Computed tomography scans were available for volume calculations on 56 (18 non-renorrhaphy and 38 renorrhaphy). Institutional review board approval was obtained. The primary outcome was %volume loss in the operated kidney, which was calculated from three-dimensional reconstructions using a semiautomatic segmentation algorithm. Multivariable regression and propensity score analysis was performed. Results: Volumetric analysis detected a difference in mean %volume loss between two-layer reconstruction (cortical renorrhaphy and base-layer) and base-layer only (15.6% versus 3.8%, p <0.001). The mean %glomerular filtration rate (GFR) loss was also greater in the two-layer group (8.9% versus 2.4%, p = 0.03). Demographics were similar between groups except the two-layer group was older, had more males, and increased ischemia time. On multivariable regression the presence of two-layer closure (β = -15.2%, p <0.001) and tumor diameter (β = -7.4, p = 0.004) were significant predictors of %volume loss while ischemia time (p = 0.88) was not. Two-layer closure remained a predictor on propensity-adjusted analysis (β = -14.3, p = 0.004). The base-layer only group had two (5.3%) urine leaks and two (5.3%) bleeding complications. The two-layer group had two (1.7%) urine leaks and three (2.5%) bleeding complications (p = 0.23, 0.41). Conclusions: Volume loss calculated from CT scans can be used to monitor postoperative renal function. Techniques for renal reconstruction and tumor diameter are associated with volume and functional loss after partial nephrectomy and should be controlled for in future studies.

AB - Introduction: To assess whether volumetric measurements can differentiate functional changes between reconstructive techniques after partial nephrectomy. Materials and methods: One hundred and fifty-six patients undergoing partial nephrectomy for a single renal mass were retrospectively studied between 2008 and 2012. Computed tomography scans were available for volume calculations on 56 (18 non-renorrhaphy and 38 renorrhaphy). Institutional review board approval was obtained. The primary outcome was %volume loss in the operated kidney, which was calculated from three-dimensional reconstructions using a semiautomatic segmentation algorithm. Multivariable regression and propensity score analysis was performed. Results: Volumetric analysis detected a difference in mean %volume loss between two-layer reconstruction (cortical renorrhaphy and base-layer) and base-layer only (15.6% versus 3.8%, p <0.001). The mean %glomerular filtration rate (GFR) loss was also greater in the two-layer group (8.9% versus 2.4%, p = 0.03). Demographics were similar between groups except the two-layer group was older, had more males, and increased ischemia time. On multivariable regression the presence of two-layer closure (β = -15.2%, p <0.001) and tumor diameter (β = -7.4, p = 0.004) were significant predictors of %volume loss while ischemia time (p = 0.88) was not. Two-layer closure remained a predictor on propensity-adjusted analysis (β = -14.3, p = 0.004). The base-layer only group had two (5.3%) urine leaks and two (5.3%) bleeding complications. The two-layer group had two (1.7%) urine leaks and three (2.5%) bleeding complications (p = 0.23, 0.41). Conclusions: Volume loss calculated from CT scans can be used to monitor postoperative renal function. Techniques for renal reconstruction and tumor diameter are associated with volume and functional loss after partial nephrectomy and should be controlled for in future studies.

KW - Carcinoma

KW - Kidney function test

KW - Partial nephrectomy

KW - Renal cell

KW - Robotics

KW - Volumetric computed tomography

UR - http://www.scopus.com/inward/record.url?scp=84932089499&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84932089499&partnerID=8YFLogxK

M3 - Article

VL - 22

SP - 7788

EP - 7796

JO - Canadian Journal of Urology

JF - Canadian Journal of Urology

SN - 1195-9479

IS - 3

ER -