title: Preoperative Prediction and Postoperative Surgeon Assessment of Volume Preservation Associated With Partial Nephrectomy: Comparison With Measured Volume Preservation.
abstract: To evaluate whether surgeons can predict the percent parenchymal mass that will be preserved by partial nephrectomy (PN) based on preoperative imaging, which could have potential utility for preoperative surgical planning and patient counseling. The proportion of preserved viable parenchyma following PN is the primary determinant of functional recovery. However, direct measurement of parenchymal volume preservation (VP) can be complex and time consuming.
  
  
  
  For patients managed with PN at our institution (2007-2014), we randomly selected 45 with a third in each of low, intermediate, or high R.E.N.A.L. complexity groups. All patients had recorded postoperative surgeon assessment of volume preservation (SAVP) and measured VP based on preoperative or postoperative computed tomography. Nine clinical providers predicted VP based solely on review of preoperative imaging while blinded to SAVP and measured VP. Clinical experience of the providers ranged from medical students to experienced urologic surgeons.
  
  
  
  Median age was 66 years, median tumor size was 4.0 cm, and median R.E.N.A.L. was 8. Median measured VP was 81% (interquartile range of 74-89%). Preoperative prediction of VP correlated poorly with measured VP among the different surgeons (mean correlation coefficient, R = 0.34, range = 0.24-0.40). Surgeon experience provided minimal incremental improvement. Correlation between R.E.N.A.L. and measured VP was also marginal (R = 0.43). In contrast, correlation between postoperative SAVP and measured VP was much more robust (R = 0.75, P <.001).
  
  
  
  Preoperative prediction of VP and R.E.N.A.L. score correlated poorly with measured VP for patients managed with PN. In contrast, postoperative SAVP provided a relatively reliable estimate of VP, and should be considered an acceptable substitute in most clinical circumstances.
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Juping
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
authors.forename: Zhiling
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Dong
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH; Imaging Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Erick M
authors.initials: EM
authors.lastname: Remer
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: Jianbo
authors.initials: J
authors.lastname: Li
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Kyle
authors.initials: K
authors.lastname: Ericson
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Tulsi
authors.initials: T
authors.lastname: Patel
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Nima
authors.initials: N
authors.lastname: Almassi
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Bryan
authors.initials: B
authors.lastname: Hinck
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zabell
authors.affiliation: Spectrum Health Hospital System, Michigan State University College of Human Medicine, Grand Rapids, MI.
authors.forename: Mouafak
authors.initials: M
authors.lastname: Tourojman
authors.affiliation: Spectrum Health Hospital System, Michigan State University College of Human Medicine, Grand Rapids, MI.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lane
authors.affiliation: Glickman Urological Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: campbes3@ccf.org.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Campbell
mesh_terms: D000368:Aged; D005260:Female; D005544:Forecasting; D006801:Humans; D007668:Kidney / Q000033:anatomy & histology* / Q000601:surgery*; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009929:Organ Size; D059351:Organ Sparing Treatments; D011184:Postoperative Period; D057234:Preoperative Period