title: Increasing volume of non-neoplastic parenchyma in partial nephrectomy specimens is associated with chronic kidney disease upstaging.
abstract: BACKGROUND
  We examined the effect of non-neoplastic parenchymal volumes (NNPVs) in partial nephrectomy (PN) surgical specimens on long-term postoperative renal function. PN for renal cortical neoplasms has demonstrated superior long-term renal function outcomes compared with radical nephrectomy. Minimizing the distance between the surgical margin and tumor will reduce the NNPV removed. The role of NNPV on postoperative outcomes has been preliminarily investigated, with varying results. Thus, we sought to determine the association between the NNPV removed and postoperative chronic kidney disease (CKD) staging.
  
  
  METHODS
  Our institutional database was queried for patients who had undergone PN from 1990 to 2012. The demographic and pathologic data were collected. The ellipsoid formula was used to calculate the surgical specimen and tumor volumes, which were then subtracted from each other to determine the NNPV. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease formula. Binary logistic regression analysis was used to determine the predictors of postoperative CKD upstaging according to the eGFR.
  
  
  RESULTS
  A total of 584 patients meeting the inclusion criteria had undergone PN. On binary logistic regression analysis, controlling for age, tumor volume, surgical modality, and preoperative CKD stage, an increasing NNPV in the surgical specimen was independently associated with postoperative CKD upstaging (odds ratio, 1.004; P = .007).
  
  
  CONCLUSIONS
  An increasing NNPV removed during PN correlated with CKD upstaging using the eGFR; therefore, additional emphasis should be placed on healthy parenchymal preservation, with long-term follow-up to ensure adequate oncologic outcomes.
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY. Electronic address: srikotamarti@gmail.com.
authors.forename: Srinath
authors.initials: S
authors.lastname: Kotamarti
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Danzig
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY.
authors.forename: Jared
authors.initials: J
authors.lastname: Levinson
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY.
authors.forename: Shumaila
authors.initials: S
authors.lastname: Saad
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY.
authors.forename: Ruslan
authors.initials: R
authors.lastname: Korets
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY.
authors.forename: James M
authors.initials: JM
authors.lastname: McKiernan
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, NY.
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology / Q000601:surgery*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D047368:Tumor Burden; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult
keywords: Ellipsoid formula; Glomerular filtration rate; Non-neoplastic parenchymal volume; Oncology; Renal function