Adherent perinephric fat in Asian patients: Predictors, and impact on perioperative outcomes of partial nephrectomy

32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom

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Adherent perinephric fat in Asian patients: Predictors, and impact on perioperative outcomes of partial nephrectomy Eur Urol Suppl 2017; 16(3);e1819

Kawamura N., Saito K., Inoue M., Ito M., Kijima T., Yoshida S., Yokoyama M., Ishioka J., Matsuoka Y., Kihara K., Fujii Y. Tokyo Medical and Dental University Graduate School, Dept. of Urology, Tokyo, Japan INTRODUCTION & OBJECTIVES: Adherent perinephric fat (APF) can increase the technical difficulty of partial nephrectomy, and is associated with adverse perioperative outcomes. The recently described Mayo adhesive probability (MAP) score is a radiological scoring system to predict APF in the Western population (Davidiuk et al. Eur Urol. 2014.) In this study, we evaluated the presence and predictors of APF and its impact on perioperative outcomes in an Asian cohort. MATERIAL & METHODS: We retrospectively collected the data of 231 consecutive patients who underwent gasless single-port partial nephrectomy (Kihara et al. Int J Urol. 2015) between 2011 and 2014. In this surgery, partial nephrectomy was done without gas insufflation and hilar clamping. If necessary, the renal hilum was clamped to control bleeding. Collected data included age at surgery, gender, body mass index, history of hypertension, diabetes, dyslipidaemia, tumour size, PADUA score, preoperative C-reactive protein, clinical T stage, MAP score, surgical parameters, and presence of APF. MAP score was calculated by one urologist based on preoperative computed tomography scans. APF was defined as perirenal fat adhering to the renal parenchyma that was described in the operative records. Patients were divided into two groups according to the presence of APF, and perioperative data were compared between the two groups. We examined the predictors of APF using univariate and multivariate logistic regression analyses. RESULTS: Of 231 patients, 59 (26%) were female. The mean body mass index was 24 kg/m2, and the mean MAP score was 1.8. APF was observed intra-operatively in 40 patients (17%). All of the patients with APF were male except for one female. Patients in the APF group were older (p = 0.01), had a higher body mass index (p < 0.001), a history of hypertension (p < 0.01), and a higher MAP score (p < 0.001) compared with patients without APF. Tumour size and tumour complexity did not differ between the two groups. Multivariate analysis without the MAP score demonstrated that male gender (odds ratio [OR] = 16.0, p < 0.001), increasing age (OR = 1.05, p < 0.01), and higher body mass index (OR = 1.21, p < 0.001) were the predictors of APF. When the MAP score was added to the multivariate analysis, male gender (p < 0.01) and MAP score (p < 0.001) were the independent predictors of APF. Estimated blood loss was higher (p < 0.01) in the APF group; however, there were no differences in the duration of surgery, rate of vascular clamping, and complication rates (Clavian-Dindo classification ≥ 3) between the two groups. No patients were converted to open surgery. CONCLUSIONS: APF was observed in 17% of Asian patients with renal tumours. MAP score and male gender were significant predictors of APF in Asian patients. APF was associated with higher blood loss

Eur Urol Suppl 2017; 16(3);e1819

32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom

1047

Adherent perinephric fat in Asian patients: Predictors, and impact on perioperative outcomes of partial nephrectomy Eur Urol Suppl 2017; 16(3);e1820

but did not increase postoperative complications in clampless partial nephrectomy.

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