title: Excised Parenchymal Mass During Partial Nephrectomy: Functional Implications.
abstract: OBJECTIVE
  To evaluate whether excised parenchymal mass (EPM) during partial nephrectomy (PN) correlates with functional decline and can serve as a surrogate for functional outcomes.
  
  
  METHODS
  All 215 patients managed with PN for unifocal renal mass with necessary studies to determine EPM and percent glomerular filtration rate (GFR) and parenchymal mass preserved (both global and specific to the operated kidney) were analyzed. EPM was estimated from the pathologic specimen by subtracting the tumor mass from the specimen mass, with both calculated using the elliptical formula. Vascularized parenchymal mass preserved was measured from computed tomography scans obtained <2 months prior and 3-12 months after surgery. All functional analyses were required to be within the same time frames, and patients with a contralateral kidney were also required to have nuclear renal scans.
  
  
  RESULTS
  The median tumor size was 3.5 cm and the median R.E.N.A.L. was 7. Warm and cold ischemia were utilized in 123 and 92 patients, respectively (median ischemia time = 23 minutes). The median global GFR preserved was 89%, the median total parenchymal mass preserved was 93%, and the median estimated EPM was 16 cm3. Whereas percent parenchymal mass preserved correlated strongly with global and ipsilateral GFR preserved (both P < .001), EPM failed to correlate with functional outcomes on both univariable and multivariable analyses.
  
  
  CONCLUSIONS
  Our data suggest that parenchymal mass preserved with standard PN by experienced surgeons associates strongly with function preserved, whereas EPM fails to correlate with functional outcomes. Further study of the functional impact of EPM in other circumstances will be required, such as enucleation or PN performed by less-experienced surgeons.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, 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 and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Zhiling
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
authors.forename: Juping
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Yantai Yuhuangding Hospital, Yantai, Shandong, China.
authors.forename: Jitao
authors.initials: J
authors.lastname: Wu
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Chalairat
authors.initials: C
authors.lastname: Suk-Ouichai
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Diego
authors.initials: D
authors.lastname: Aguilar Palacios
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Elvis
authors.initials: E
authors.lastname: Caraballo Antonio
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Sanam
authors.initials: S
authors.lastname: Babbar
authors.affiliation: Glickman Urological and 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 and 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 and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Isharwal
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zabell
authors.affiliation: Glickman Urological and 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; D002681:China; D002983:Clinical Competence / Q000592:standards; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards; D009929:Organ Size; D059351:Organ Sparing Treatments / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D020127:Recovery of Function; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden