Authors (including presenting author) :
Cheng CH(1), Law VTT(1), Lo TK(1), Lee YK(1), Chan TY(1), Chau H(1), Chu PSK(1), Man CW(1)
Affiliation :
(1) Department of Surgery, Tuen Mun Hospital
Introduction :
Partial nephrectomy is the standard of care of localized renal tumor if technically feasible. However, it is a challenging operation to achieve good oncological control, to preserve renal function and to minimize perioperative complications. Most of the operation usually had conventional CT only for preoperative planning and there is paucity of studies that report into the utilization of three-dimensional (3D) reconstruction of image for open partial nephrectomy (OPN).
Objectives :
To retrospectively analyze the clinical implications of preoperative 3D image reconstruction on the surgical outcome of open partial nephrectomy.
Methodology :
127 cases of open partial nephrectomy in Tuen Mun Hospital from January 2015 to December 2022 was retrospectively reviewed. Preoperative 3D image reconstruction was implemented in September 2020. The cases was divided into 2 groups: 3D image reconstruction guided OPN group (3D-OPN) and control group. Patient’s demographics, tumor characteristics, surgical parameters and clinical outcomes were collected and compared with the use of SPSS for statistical analysis.
Result & Outcome :
The study included 26 cases of 3D-OPN and 101 control OPN. Both groups shared similar demographics and performance status but the 3D-OPN group had more patients with higher anesthetic risk i.e. ASA 3 or above (31% vs 4%, P<0.001). The renal tumor of both groups were of similar size and complexity. Surgically there was no significance difference in mean intraoperative blood loss and artery clamping technique performed. Although the mean operative time was significantly higher in 3D-OPN (246 minutes vs 201 minutes, P<0.001), this group resulted in less perioperative major complications (8% vs 24% P = 0.07) and earlier recovery of renal function i.e. 90% of estimated Glomerular Filtration Rate (eGFR) preserved in postoperative 3 months (58% vs 30%, P = 0.025). The trifecta achievement (i.e. a combination of negative surgical margin, 90% preservation of eGFR at first postoperative clinical visit and absence of major complications) rate was also higher in the 3D-OPN group (53% vs 22%, P = 0.01). In conclusion, utilization of 3D kidney image reconstruction for preoperative planning can reduce the risks of major complications, allow earlier renal function recovery and improve clinical outcome of open partial nephrectomy.
