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Analysis of the impact of adherent perirenal fat on peri-operative outcomes of robotic partial nephrectomy

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Abstract

Introduction

Adherent perirenal fat (APF) can be defined as inflammatory fat sticking to renal parenchyma, whose dissection is difficult and makes it troublesome to expose the tumour. Our objective was to evaluate the impact of APF on the technical difficulty of robot-assisted partial nephrectomy (RPN).

Patients and methods

We analysed data of 202 patients who underwent RPN for a small renal tumour. Patients were divided into two groups according to the presence of APF. Peri-operative data were compared between the two groups. Predictors of APF were evaluated by univariate and multivariate analysis. The validity of the MAP score (radiological scoring system) was also assessed.

Results

APF was observed in 80 patients (39.6 %). Tumour complexity and surgeon’s experience were similar between both groups. Operative time was 40 min longer in the APF group (188.5 vs. 147.9 min, p < 0.0001). Blood loss was twice higher, and transfusions were more common in the APF group (694 vs. 330 ml, p < 0.0001 and 19 vs. 5.8 %, p = 0.003, respectively). APF was associated with an increased risk of conversion to open surgery (11.2 vs. 0 %, p = 0.0002) or radical nephrectomy (6.2 vs. 0.8 %, p = 0.03). In multivariate analysis, male gender (OR 13.2, p < 0.0001), obesity (OR 1.2, p = 0.007), hypertension (OR 3.7, p = 0.02), and MAP score (OR 3.3; p < 0.0001) were significant predictors of APF.

Conclusion

During RPN, APF is associated with increased bleeding and a higher risk of conversion to open surgery and to radical nephrectomy. Male gender, hypertension, obesity, and MAP score are predictors of APF.

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The authors declare that they have no conflict of interest.

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    Authors and Affiliations

    1. Department of Urology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033, Rennes Cedex, France

      Zine-Eddine Khene, Benoit Peyronnet, Romain Mathieu, Tarek Fardoun, Grégory Verhoest & Karim Bensalah

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    1. Zine-Eddine Khene
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    2. Benoit Peyronnet
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    3. Romain Mathieu
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    Correspondence to Zine-Eddine Khene.

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    Zine-Eddine Khene and Benoit Peyronnet have contributed equally to this work.

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    Khene, ZE., Peyronnet, B., Mathieu, R. et al. Analysis of the impact of adherent perirenal fat on peri-operative outcomes of robotic partial nephrectomy. World J Urol 33, 1801–1806 (2015). https://doi.org/10.1007/s00345-015-1500-0

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    • DOI: https://doi.org/10.1007/s00345-015-1500-0

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