title: Prospective evaluation of the association of adherent perinephric fat with perioperative outcomes of robotic-assisted partial nephrectomy.
abstract: OBJECTIVE
  To prospectively analyze the association of adherent perinephric fat (APF) with perioperative outcomes of robotic-assisted partial nephrectomy (RAPN).
  
  
  METHODS
  We analyzed 100 consecutive RAPNs performed by a single experienced surgeon and defined APF as the necessity of subcapsular renal dissection to mobilize the kidney and isolate the renal tumor for RAPN. Our primary analysis focused on comparing perioperative outcomes, including operative time, warm ischemia time, estimated blood loss, postoperative complications, length of stay, and margins, ischemia, and complications score between patients with and without APF. To control the probability of obtaining a false-positive finding at 5% after the numerous statistical comparisons that were performed, we used a Bonferroni correction for multiple comparisons, after which P values of ≤.0042 were considered to be statistically significant.
  
  
  RESULTS
  Thirty patients (30%) had APF. Presence of APF was not significantly associated with blood loss, warm ischemia time, hospital stay, postoperative complications, or margins, ischemia, and complications score. We noted some evidence of longer operative times in patients with APF compared with those without APF (median, 223 vs199 minutes; P = .026); however, this was not significant after adjustment for multiple comparisons. In multivariate analysis, we noted stronger evidence of associations with increased operative time for RENAL score (P <.001) and body mass index (P = .020) than for the presence of APF (P = .32).
  
  
  CONCLUSIONS
  APF may be associated with slightly longer operative times but does not appear to affect perioperative complications or outcomes.
authors: Department of Urology, Mayo Clinic, Jacksonville, FL.
authors: Andrew J
authors: AJ
authors: Davidiuk
authors: Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL.
authors: Alexander S
authors: AS
authors: Parker
authors: Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL.
authors: Colleen S
authors: CS
authors: Thomas
authors: Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL.
authors: Michael G
authors: MG
authors: Heckman
authors: Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL.
authors: Kaitlynn
authors: K
authors: Custer
authors: Department of Urology, Mayo Clinic, Jacksonville, FL. Electronic address: Thiel.David@mayo.edu.
authors: David D
authors: DD
authors: Thiel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome; D047368:Tumor Burden; D052096:Warm Ischemia; D055815:Young Adult