Publication: Laparoskopik Parsiyel Nefrektomi Yapılan Hastalarda Böbrek Parankim Hacmindeki Değişikliği Etkileyen Faktörler ile Böbrek Fonksiyonlarındaki Değişimin İlişkisi
Abstract
Amaç: Laparoskopik parsiyel nefrektomi (LPN) sonrasında renal fonksiyonun değişimine etki eden parametrelerin ve bu parametrelerden biri olduğu bilinen böbrek parankim hacmine etki eden faktörlerin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Ekim 2012 ile Ocak 2023 tarihleri arasında LPN yapılan, ameliyat görüntülerine ulaşılabilen, preoperatif ve postoperatif aynı kesitsel görüntüleme yöntemi ile değerlendirilen, en az bir yıllık takipleri olan toplam 187 hasta çalışmaya dahil edildi. Bilateral renal kitlesi olan, sekonder parsiyel nefrektomi yapılan ve soliter böbrekli hastalar çalışma dışı bırakıldı. Olguların preoperatif demografik ve klinik verileri her hasta için kaydedildi. Preoperatif radyolojik görüntülemelerden kitle boyutu, Mayo Yapışkanlık Olasılığı (MAP), RENAL ve PADUA skoru verileri hesaplandı. Cerrahi süre, iskemi tipi ve süresi, intraoperatif ultrasonografi kullanımı, Surface-Intermediate-Base (SIB) skoru gibi intraoperatif veriler kaydedildi. Hastaların preoperatif ve postoperatif (1.yıl, 2.yıl, 3.yıl, 4.yıl, 5.yıl, 6.yıl) radyolojik görüntüleri ''3D Slicer'' programı kullanılarak üç boyutlu hale getirildi ve hacim ile yüzey alanı ölçümleri bu üç boyutlu şekiller üzerinden yazılım yardımı ile yapıldı. Renal fonksiyonları değerlendirmek için preoperatif ve postoperatif 1.gün, 1.ay, 6.ay, 1.yıl, 2.yıl, 3.yıl, 4.yıl, 5.yıl, 6.yıl, tahmini glomerüler filtrasyon hızı (eGFR) değerleri kaydedildi. Bulgular: Yaş ortancası 58 yıl olan 187 olgunun 88'i kadın 99'u erkekti ve % 17,6'sında diabetes mellitus, % 45,5'inde hipertansiyon tanısı mevcuttu. Vücut kitle indeksi ortancası 28,5 kg/m² idi. 88 hasta preoperatif ve postoperatif bilgisayarlı tomografi ile değerlendirilirken 99 hasta manyetik rezonans görüntüleme ile değerlendirildi. Kitle hacminin ortancası 25,8 cm3, kitlenin parankim ile temas yüzey alanı ortancası 16 cm² olarak hesaplandı. RENAL skor ortancası 7, PADUA skoru ortancası 8, MAP skoru ortancası 1 olarak hesaplandı. Sıcak iskemi süresi ortancası 14 dk, cerrahi süre ortancası 80 dk, SIB skoru ortancası ise 4 olarak bulundu. Preoperatif kitlesiz böbrek hacmi ortalaması 168,8 cm3, postoperatif 1. yıl opere böbrek hacmi ortalaması 146 cm3 olarak hesaplandı ve anlamlı azalma gözlendi (p <0,001). Preoperatif kontralateral böbrek hacmi ortalaması 169,81 cm3, postoperatif 1.yıl kontralateral böbrek hacmi ortalaması ise 173,53 cm3 olarak hesaplandı ve anlamlı artış gözlendi (p <0,001). Preoperatif eGFR ortancası 93,62 ml/dk iken postoperatif 1.yıl eGFR ortancası ise 88,7 ml/dk olarak hesaplandı ve anlamlı azalış gözlendi (p <0,001). Postoperatif 1.yıldan sonraki bilateral böbrek hacimlerinde anlamlı değişme gözlenmezken eGFR değerinde istatistiksel anlamlı düşüş gözlendi (p <0,001). Yapılan regresyon analizinde eGFR düşüşüne etki eden faktörler postoperatif 1.yılda; kitle ile parankim temas yüzey alanı, yaş ve opere böbrek hacmindeki azalış, postoperatif 2.yılda; yaş, opere böbrek hacmindeki azalış ve cinsiyet, postoperatif 3. yılda ise opere böbrek hacmindeki azalış, vücut kitle indeksi, diabetes mellitus varlığı olarak tespit edildi. Yapılan regresyon analizinde opere böbrek hacmindeki azalışa etki eden faktörler postoperatif 1. yılda; yaş, cerrahi süre, SIB skoru, komorbidite varlığı, postoperatif 2. yılda ise yaş, cerrahi süre, SIB skoru olarak tespit edildi. Sonuç: LPN ipsilateral böbrekte hacim kaybı, kontralateral böbrek hacminde artış ve böbrek fonksiyonlarında azalma ile sonuçlanmaktadır. Renal fonksiyonun değişimine etki eden faktörler; yaş, cinsiyet, diabetes mellitus varlığı, kitle ile parankim temas yüzey alanı ve opere böbrek parankim hacmidir. Opere böbrekte parankim hacmi değişimine etki eden faktörler ise yaş, komorbidite varlığı, RENAL skor, cerrahi süre ve SIB skorudur. Anahtar Kelimeler: Renal hücreli karsinom, Laparoskopik parsiyel nefrektomi, Üç Boyutlu Görüntüleme, Parankimal Volüm, Böbrek Fonksiyonu
Objective: This study aims to evaluate the parameters affecting the changes in renal function after laparoscopic partial nephrectomy and the factors influencing the renal parenchymal volume, known as one of these parameters. Materials and Methods: One hundred eighty-seven patients who underwent laparoscopic partial nephrectomy between October 2012 and January 2023, with operation video records and pre and postoperative radiologic images using the same imaging modality and with a minimum follow-up of one year, were included in the study. Patients with bilateral renal masses who had undergone secondary partial nephrectomy and with a solitary kidney were excluded from the study. The preoperative demographic and clinical data were recorded for each patient. Tumor size, Mayo Adhesive Probability (MAP), RENAL, and PADUA scores were calculated. Intraoperative data such as operation and ischemia time, ischemia type, usage of intraoperative ultrasonography, and Surface-Intermediate-Base (SIB) score were collected from operation video records. The preoperative and postoperative (1 to 6 years) radiological images of the patients were converted into three-dimensional (3D) models using the '3D Slicer' program. Volume and surface area measurements were performed on these 3D models with the software. To evaluate renal function, preoperative and postoperative (day 1, month 1, month 6, year 1 to 6) estimated glomerular filtration rate (eGFR) values were recorded. Results: Of the 187 cases with a median age of 58 years, 88 were female, and 99 were male, with 17.6% diagnosed with diabetes mellitus and 45.5% with hypertension. The median body mass index was 28.5 kg/m². Eighty-eight patients were evaluated with preoperative and postoperative computed tomography, and 99 with magnetic resonance imaging. The median tumour volume was 25.8 cm³, and the median surface area of tumour contact with the parenchyma was 16 cm². The median of RENAL, PADUA and MAP scores were 7, 8, and 1, respectively. The median warm ischemia time was 14 minutes, the median operation time was 80 minutes, and the median SIB score was 4. The mean preoperative tumor-free kidney volume was 168.8 cm³, and the mean postoperative 1-year operated kidney volume was 146 cm³, showing a significant decrease (p <0.001). The mean preoperative contralateral kidney volume was 169.81 cm³, and the mean postoperative 1-year contralateral kidney volume was 173.53 cm³, showing a significant increase (p <0.001). The median preoperative eGFR was 93.62 ml/min, while the median postoperative 1-year eGFR was 88.71 ml/min, showing a significant decrease (p <0.001). No significant changes were observed in the bilateral kidney volumes after the first postoperative year, but a statistically significant reduction was found in the eGFR values (p <0.001). Regression analysis identified factors affecting eGFR decline in the first postoperative year, such as the surface area of tumor contact with the parenchyma, age, and reduced kidney volume. These factors are age, a reduction in operated kidney volume and gender in the second postoperative year, a reduction in operated kidney volume, body mass index, and diabetes mellitus in the third postoperative year. Factors affecting the decreased operated kidney volume in the first postoperative year were identified as age, surgical duration, SIB score, and presence of comorbidities, while in the second postoperative year, age, surgical duration, and SIB score were identified. Conclusion: Laparoscopic partial nephrectomy results in our study showed volume loss in the ipsilateral kidney with contralateral hypertropia and a decrease in renal function. Factors affecting renal function include age, gender, presence of diabetes mellitus, the surface area of tumor contact with the parenchyma, and the volume of the operated kidney parenchyma. Factors affecting changes in the parenchymal volume of the operated kidney include age, presence of comorbidities, RENAL score, surgical duration, and SIB score. Age, comorbidities, the RENAL score, operation time, and the SIB score are among the variables influencing changes in the parenchymal volume of the operated kidney. Keywords: Renal Cell Carcinoma, Laparoscopic Partial Nephrectomy, Three-Dimensional Imaging, Parenchymal Volume, Renal Function
Objective: This study aims to evaluate the parameters affecting the changes in renal function after laparoscopic partial nephrectomy and the factors influencing the renal parenchymal volume, known as one of these parameters. Materials and Methods: One hundred eighty-seven patients who underwent laparoscopic partial nephrectomy between October 2012 and January 2023, with operation video records and pre and postoperative radiologic images using the same imaging modality and with a minimum follow-up of one year, were included in the study. Patients with bilateral renal masses who had undergone secondary partial nephrectomy and with a solitary kidney were excluded from the study. The preoperative demographic and clinical data were recorded for each patient. Tumor size, Mayo Adhesive Probability (MAP), RENAL, and PADUA scores were calculated. Intraoperative data such as operation and ischemia time, ischemia type, usage of intraoperative ultrasonography, and Surface-Intermediate-Base (SIB) score were collected from operation video records. The preoperative and postoperative (1 to 6 years) radiological images of the patients were converted into three-dimensional (3D) models using the '3D Slicer' program. Volume and surface area measurements were performed on these 3D models with the software. To evaluate renal function, preoperative and postoperative (day 1, month 1, month 6, year 1 to 6) estimated glomerular filtration rate (eGFR) values were recorded. Results: Of the 187 cases with a median age of 58 years, 88 were female, and 99 were male, with 17.6% diagnosed with diabetes mellitus and 45.5% with hypertension. The median body mass index was 28.5 kg/m². Eighty-eight patients were evaluated with preoperative and postoperative computed tomography, and 99 with magnetic resonance imaging. The median tumour volume was 25.8 cm³, and the median surface area of tumour contact with the parenchyma was 16 cm². The median of RENAL, PADUA and MAP scores were 7, 8, and 1, respectively. The median warm ischemia time was 14 minutes, the median operation time was 80 minutes, and the median SIB score was 4. The mean preoperative tumor-free kidney volume was 168.8 cm³, and the mean postoperative 1-year operated kidney volume was 146 cm³, showing a significant decrease (p <0.001). The mean preoperative contralateral kidney volume was 169.81 cm³, and the mean postoperative 1-year contralateral kidney volume was 173.53 cm³, showing a significant increase (p <0.001). The median preoperative eGFR was 93.62 ml/min, while the median postoperative 1-year eGFR was 88.71 ml/min, showing a significant decrease (p <0.001). No significant changes were observed in the bilateral kidney volumes after the first postoperative year, but a statistically significant reduction was found in the eGFR values (p <0.001). Regression analysis identified factors affecting eGFR decline in the first postoperative year, such as the surface area of tumor contact with the parenchyma, age, and reduced kidney volume. These factors are age, a reduction in operated kidney volume and gender in the second postoperative year, a reduction in operated kidney volume, body mass index, and diabetes mellitus in the third postoperative year. Factors affecting the decreased operated kidney volume in the first postoperative year were identified as age, surgical duration, SIB score, and presence of comorbidities, while in the second postoperative year, age, surgical duration, and SIB score were identified. Conclusion: Laparoscopic partial nephrectomy results in our study showed volume loss in the ipsilateral kidney with contralateral hypertropia and a decrease in renal function. Factors affecting renal function include age, gender, presence of diabetes mellitus, the surface area of tumor contact with the parenchyma, and the volume of the operated kidney parenchyma. Factors affecting changes in the parenchymal volume of the operated kidney include age, presence of comorbidities, RENAL score, surgical duration, and SIB score. Age, comorbidities, the RENAL score, operation time, and the SIB score are among the variables influencing changes in the parenchymal volume of the operated kidney. Keywords: Renal Cell Carcinoma, Laparoscopic Partial Nephrectomy, Three-Dimensional Imaging, Parenchymal Volume, Renal Function
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