title: Renal mass anatomic characteristics and perioperative outcomes of laparoscopic partial nephrectomy: a critical analysis.
abstract: OBJECTIVE
  Anatomic parameters determining renal mass complexity have been used in a number of proposed scoring systems despite lack of a critical analysis of their independent contributions. We sought to assess the independent contribution of anatomic parameters on perioperative outcomes of laparoscopic partial nephrectomy (LPN).
  
  
  METHODS
  Preoperative imaging studies were reviewed for 147 consecutive patients undergoing LPN for a single renal mass. Renal mass anatomy was recorded: Size, growth pattern (endo-/meso-/exophytic), centrality (central/hilar/peripheral), anterior/posterior, lateral/medial, polar location. Multivariable models were used to determine associations of anatomic parameters with warm ischemia time (WIT), operative time (OT), estimated blood loss (EBL), intra- and postoperative complications, as well as renal function. All models were adjusted for the learning curve and relevant confounders.
  
  
  RESULTS
  Median (range) tumor size was 3.3 cm (1.5-11 cm); 52% were central and 14% hilar. While 44% were exophytic, 23% and 33% were mesophytic and endophytic, respectively. Anatomic parameters did not uniformly predict perioperative outcomes. WIT was associated with tumor size (P=0.068), centrality (central, P=0.016; hilar, P=0.073), and endophytic growth pattern (P=0.017). OT was only associated with tumor size (P<0.001). No anatomic parameter predicted EBL. Tumor centrality increased the odds of overall and intraoperative complications, without reaching statistical significance. Postoperative renal function was not associated with any of the anatomic parameters considered after adjustment for baseline function and WIT. Learning curve, considered as a confounder, was independently associated with reduced WIT and OT as well as reduced odds of intraoperative complications.
  
  
  CONCLUSIONS
  This study provides a detailed analysis of the independent impact of renal mass anatomic parameters on perioperative outcomes. Our findings suggest diverse independent contributions of the anatomic parameters to the different measures of outcomes (WIT, OT, EBL, complications, and renal function) emphasizing the importance of the learning curve.
authors.affiliation: Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. atsivian@hotmail.com
authors.forename: Matvey
authors.initials: M
authors.lastname: Tsivian
authors.forename: Said
authors.initials: S
authors.lastname: Ulusoy
authors.forename: Michael
authors.initials: M
authors.lastname: Abern
authors.forename: Ayelet
authors.initials: A
authors.lastname: Wandel
authors.forename: A Ami
authors.initials: AA
authors.lastname: Sidi
authors.forename: Alexander
authors.initials: A
authors.lastname: Tsivian
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology*; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D011184:Postoperative Period; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed