Perinephric Fat For Laparoscopic Partial Nephrectomy Predictive Value Of Peri-operation Outcome

?OBJECTIVE?To investigate the effect of perinephric fat for the difficulty and perioperative outcomes of the laparoscopic partial nephrectomy,as well as the prediction function of perioperative outcomes complication of the laparoscopic partial nephrectomy which affected by the perinephric fat thickness and MAP.?METHODS?First part: Retrospectively reviewed 84 cases of laparoscopic partial nephrectomy(LPN)between June 2013 and August 2014 by a single surgeon in our dept,which all these cases' preoperative imaging data,30 days follow-up data are available.Measurement of preoperative imaging under the perinephric fat(abdominal fat,IAF),RENAL score,tumor size,data as patients' general information(age,gender,ASA score),and perioperative outcomes varieties(Clavien degrees complications,operation time,warm ischemia time)were carried out to analyze;Second part: Retrospectively reviewed 142 cases of laparoscopic partial nephrectomy(LPN)between June 2013 and February 2015 by a single surgeon in our dept,which all these cases' preoperative imaging data,30 days follow-up data are available.Measurement of preoperative image Mayo adherent score(MAP),RENAL score,tumor size,data as patients' general information and perioperative outcomes were carried out for analyze.?RESULT?First part: In total,90 cases were reviewed during the study period,of which 84 had complete preoperative imaging data.Of these cases,the average operation time was 143.93 ±60.11 minutes,the mean warm ischemia time was 24.44 ±7.68 minutes.A total of 23 cases(27.4%)had grade I-IV complications within 30 days of surgery,6(7.1%)of which were grade III-IV.No patient experienced a grade V complication.On univariate analysis,there is a significant difference in perinephric fat of different operation time groups(p=0.003);In generalized linear model,the perinephric fat was an independent risk factors of operative time(p<0.001),while it was not found to be independently associated with either the LPN warm ischemia time or the postoperative complications.Second part: In total,142 cases were reviewed during the study period,of which all had complete preoperative imaging data.Of these cases,the average operation time was 141.03 ±55.94 minutes,the mean warm ischemia time was 24.16 ±6.68 minutes.A total of 38 cases(26.1%)had grade I-IV complications within 30 days of surgery,7(4.9%)of which were grade III-IV.No patient experienced a grade V complication.On univariate analysis,there is a significant difference in MAP of different operation time groups(p<0.001),of different warm ischemia groups(p=0.019),as well as between complication group and non complication group(p<0.001).In generalized linear model,MAP was an independent risk factors of both the operation time(p=0.021)and the incidence of complications(p=0.002).?Conclusion? The perinephric fat thickness has predictive value for LPN operation time,while MAP has predictive value for both LPN operation time and complication rate.The operation time and the complication rate are affected by the size of tumor.the main independent factors of warm ischemia time was RENAL score.