Impact of preoperative calculation of nephron volume loss on future of partial nephrectomy techniques; planning a strategic roadmap for improving functional preservation and securing oncological safety

Objectives To assess the correlation of resected and ischaemised volume (RAIV), which is preoperatively calculated volume of nephron loss (VNL), with the amount of postoperative renal function (PRF) decline after minimally invasive partial nephrectomy (PN) in a multi-institutional dataset. Subjects and Methods We identified 348 patients from March 2005 to December 2013 at six institutions. Data on all cases of laparoscopic (n = 85) and robotic PN (n = 263) performed were retrospectively gathered. Univariable and multivariable linear regression analyses were utilised to identify the associations between various time points of PRF and RAIV as a continuous variable. Results Mean RAIV was 24.2 ± 29.2 cm3. Mean preoperative eGFR and eGFRs at postoperative day 1, 6 months and 3 years follow-up was 91.0 and 76.8, 80.2 and 87.7 ml/min per 1.73 m2, respectively. In multivariable linear regression analysis, the amount of changes in PRF in long-term follow-up were significantly correlated with RAIV (β = 0.261, β = 0.165, β = 0.260 at postoperative day 1, 6 months and 3 years follow-up, respectively). This study has the limitation of its retrospective nature. Conclusion Preoperatively calculated RAIV significantly correlates with the amount of changes in PRF during long-term follow-up. RAIV could lead our research to the level of prediction of the amount of PRF decline. RAIV provides appropriate evidence to explain the technical advantages of emerging techniques. This article is protected by copyright. All rights reserved.