Two-year analysis for predicting renal function and contralateral hypertrophy after robot-assisted partial nephrectomy: A three-dimensional segmentation technology study.
OBJECTIVE
To analyze long-term changes in both kidneys, and to predict renal function and contralateral hypertrophy after robot-assisted partial nephrectomy.


METHODS
A total of 62 patients underwent robot-assisted partial nephrectomy, and renal parenchymal volume was calculated using three-dimensional semi-automatic segmentation technology. Patients were evaluated within 1 month preoperatively, and postoperatively at 6 months, 1 year and continued up to 2-year follow up. Linear regression models were used to identify the factors predicting variables that correlated with estimated glomerular filtration rate changes and contralateral hypertrophy 2 years after robot-assisted partial nephrectomy.


RESULTS
The median global estimated glomerular filtration rate changes were -10.4%, -11.9%, and -2.4% at 6 months, 1 and 2 years post-robot-assisted partial nephrectomy, respectively. The ipsilateral kidney median parenchymal volume changes were -24%, -24.4%, and -21% at 6 months, 1 and 2 years post-robot-assisted partial nephrectomy, respectively. The contralateral renal volume changes were 2.3%, 9.6% and 12.9%, respectively. On multivariable linear analysis, preoperative estimated glomerular filtration rate was the best predictive factor for global estimated glomerular filtration rate change on 2 years post-robot-assisted partial nephrectomy (B -0.452; 95% confidence interval -0.84 to -0.14; P = 0.021), whereas the parenchymal volume loss rate (B -0.43; 95% confidence interval -0.89 to -0.15; P = 0.017) and tumor size (B 5.154; 95% confidence interval -0.11 to 9.98; P = 0.041) were the significant predictive factors for the degree of contralateral renal hypertrophy on 2 years post-robot-assisted partial nephrectomy.


CONCLUSIONS
Preoperative estimated glomerular filtration rate significantly affects post-robot-assisted partial nephrectomy renal function. Renal mass size and renal parenchyma volume loss correlates with compensatory hypertrophy of the contralateral kidney. Contralateral hypertrophy of the renal parenchyma compensates for the functional loss of the ipsilateral kidney.
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Dae Keun
DK
Kim
Department of Multimedia Engineering, Seoul Women's University, Seoul, Korea.
Yujin
Y
Jang
Department of Multimedia Engineering, Seoul Women's University, Seoul, Korea.
Jaeseon
J
Lee
Department of Multimedia Engineering, Seoul Women's University, Seoul, Korea.
Helen
H
Hong
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Ki Hong
KH
Kim
Department of Urology, Chuncheon Sacred Hospital, Hallym University College of Medicine, Chuncheon, Korea.
Tae Young
TY
Shin
Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
Dae Chul
DC
Jung
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Young Deuk
YD
Choi
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Koon Ho
KH
Rha
D000222:Adaptation, Physiological; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006984:Hypertrophy / Q000000981:diagnostic imaging / Q000503:physiopathology; D021621:Imaging, Three-Dimensional; D007668:Kidney / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D009929:Organ Size; D065287:Robotic Surgical Procedures; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden
D003287:Contrast Media
hypertrophy; kidney; nephrectomy; robotics; segmentation