MAAUA: MAAUA 68th Annual Meeting Abstracts - Preoperative Predictors of Method of Nephron Sparing Surgery

MAAUA 68th Annual Meeting Abstracts

Preoperative Predictors of Method of Nephron Sparing Surgery
Jamie C Messer, Jay D Raman, Carl T Reese, Lewis E Harpster, Ross M Decter
Penn State Milton S Hershey Medical Center, Hershey, PA

Introduction: During the past two decades, management of small renal masses has expanded to include nephron sparing surgery (NSS). We sought to evaluate disease characteristics that contributed to the selection of open versus laparoscopic NSS.
Materials and Methods: We reviewed NSS procedures performed at our institution and evaluated the preoperative patient and imaging characteristics which contributed to selection of an open (versus laparoscopic) operation by surgeons comfortable with both approaches. Univariate and multivariate analyses were performed to identify factors associated with a higher risk of open NSS.
Results: 229 consecutive NSS, including 130 open partial nephrectomies and 99 laparoscopic partial nephrectomies, were reviewed. Median age was 59 years, BMI was 30, size of the tumor was 3.00 cm, and preoperative GFR was 81. Of these patients 39% were female and 61% were male. On univariate analysis, preoperative GFR (p=0.05), a history of contralateral RCC (p=0.02), tumor size (p=0.04), collecting system involvement (p=0.04), renal hilar tumors (p=0.02), and multifocality (p=0.006) all were associated with an open surgical approach. In a multivariate model incorporating these 6 variables, only renal hilar location (OR 2.63, 95% CI 1.17-5.88, p=0.02) remained significantly associated with open NSS.
Conclusions: Many parameters including increasing BMI, preoperative GFR, prior abdominal surgery, endophytic tumor location, and collecting system involvement do not necessarily preclude a minimally invasive PN. In our experience, renal hilar tumors were over 2.5 fold more likely to be managed by open PN likely owing to the complexity of resection.

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