Parenchymal volume analysis and functional recovery after partial and radical nephrectomy for renal cell carcinoma
DOI:
https://doi.org/10.52786/isu.a.105Keywords:
Renal cell carcinoma, functional outcomes, parenchymal volume analysis, ischemic time, partial nephrectomyAbstract
Renal cell carcinoma (RCC) accounts for 2–3% of adult malignancies and has the highest mortality among genitourinary cancers. With the increasing use of cross-sectional imaging, RCC is now frequently diagnosed incidentally and at earlier stages, and partial nephrectomy (PN) has become the standard treatment for small renal masses. In appropriately selected patients, PN can significantly reduce the risk of chronic kidney disease (CKD), CKD-related mortality, and cardiovascular events. In cases where PN is high-risk or not feasible, radical nephrectomy (RN) remains a valid alternative, particularly when the new baseline glomerular filtration rate (NBGFR) is anticipated to be greater than 45 ml/min/1.73 m2.
Functional recovery after surgery depends on multiple factors. Among these, parenchymal volume loss has been identified as the primary determinant, accounting for 70–80% of the decline in function associated with PN. Ischemia, particularly warm ischemia exceeding 30 minutes, can also contribute to renal impairment albeit to a lesser extent. Cold ischemia has a comparatively minor effect and is generally protective. Vascularized parenchymal loss results from both tumor resection and devascularization during reconstruction, with the latter playing the predominant role. Preserving well-perfused renal parenchyma is thus crucial for optimal recovery.
To analyze functional recovery after PN, accurate estimates of split renal function (SRF) are required to evaluate outcomes specific to the kidney exposed to ischemia. Our recent studies have used parenchymal volume analysis (PVA) rather than nuclear renal scans to estimate SRF, and this has allowed us to provide a more discerning analysis. PVA presumes that the amount of parenchyma on each side is proportionate to its function and this approach has proven to be more accurate than nuclear renal scans
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