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Minerva Urologica e Nefrologica 2020 Jan 30

DOI: 10.23736/S0393-2249.20.03698-X


lingua: Inglese

Clinical predictors and significance of adherent perinephric fat assessed with Mayo Adhesive Probability (MAP) score and Perinephric Fat Surface Density (PnFSD) at the time of partial nephrectomy for localized renal mass. A single high-volume referral centre experience

Fabrizio DI MAIDA 1, Gianni VITTORI 1, Riccardo CAMPI 1, Andrea MARI 1, Riccardo TELLINI 1, Simone SFORZA 1, Francesco SESSA 1, Silvia LUCARINI 2, Vittorio MIELE 2, Linda VIGNOZZI 3, Lorenzo MASIERI 1, Marco CARINI 1, Andrea MINERVINI 1

1 Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, University of Florence, Careggi Hospital, Florence, Italy; 2 Department of Radiology, University of Florence, Careggi Hospital, Florence, Italy; 3 Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, AOU Careggi, Florence, Italy


INTRODUCTION: Adherent perinephric fat (APF) could negatively influence surgical outcomes of partial nephrectomy (PN). Novel radiological scores have been introduced to preoperatively detect APF, i.e. Mayo Adhesive Probability (MAP) score and Perinephric Fat Surface Density (PnFSD). We aimed to evaluate clinical predictors of APF and the association of MAP and PnFSD with perioperative outcomes after PN.
METHODS: Clinical and radiological data of patients undergoing open or robotic PN were prospectively gathered. Perinephric fat was retrospectively measured by a single expert uroradiologist. Patients were divided into MAP 0-3 vs MAP 4-5 and high vs low PnFSD. Multivariable analysis was performed to seek for clinical predictors of APF.
RESULTS: Overall, 175 patients were entered. Patients with vs without APF were significantly different regarding age, gender, ASA score, Charlson Comorbidity Index, Body Mass Index, waist circumference, HDL status and metabolic syndrome. Conversely, tumor-related characteristics were not significantly different between the groups. At multivariable analysis, metabolic syndrome was confirmed as the only independent predictor of APF (OR:24.9; p<0.001). Notably, APF assessed by MAP score or PnFSD was not associated with perioperative outcomes after PN.
CONCLUSIONS: In experienced hands, APF did not impact on intra- or perioperative outcomes after PN. Metabolic syndrome was the only significant predictor of APF in our series.

KEY WORDS: Adherent perinephric fat; Mayo Adhesive Probability (MAP) score; Partial nephrectomy; Perinephric Fat Surface Density (PnFSD); Kidney cancer

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