1639 AN OBESE BODY HABITUS DOES NOT PRECLUDE A MINIMALLY INVASIVE PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized (IV)1 Apr 20131639 AN OBESE BODY HABITUS DOES NOT PRECLUDE A MINIMALLY INVASIVE PARTIAL NEPHRECTOMY Christopher Reynolds, Michael Hannon, Kathleen Lehman, Lewis Harpster, and Jay Raman Christopher ReynoldsChristopher Reynolds Hershey, PA More articles by this author , Michael HannonMichael Hannon Hershey, PA More articles by this author , Kathleen LehmanKathleen Lehman Hershey, PA More articles by this author , Lewis HarpsterLewis Harpster Hershey, PA More articles by this author , and Jay RamanJay Raman Hershey, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3105AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Obesity has increasingly becoming a public health epidemic with multiple studies highlighting an association with renal cell carcinoma (RCC). Partial nephrectomy (PN) via open or minimally invasive (MI) techniques is the referent standard for managing RCC whenever possible. Outcomes of MIPN in the obese patient population are incompletely defined. We investigate the feasibility of MIPN in obesity class I - III patients by comparison of surgical outcomes to those with a lower body mass index (BMI). METHODS The electronic medical records of 184 consecutive patients undergoing MIPN via laparoscopic (n=109) or robotic (n=75) techniques were reviewed. Patients were classified into the following patient cohorts stratified by BMI: 1) BMI < 30; 2) BMI 30-35 - obesity class I; 3) BMI 35-40 - obesity class II; 4) BMI > 40 - obesity class III. Clinical, radiographic, procedural, and pathologic data were collected. The association between obesity class and operative duration, EBL, length of stay, complications, and margin status was determined. RESULTS 95 men and 89 women with a median age of 55 years, BMI of 31, tumor size of 2.9cm (range, 0.7 - 10.2), and RENAL nephrometry score of 6 (range, 4 - 10) were included. Median operative duration was 218 minutes, ischemia duration was 23.5 minutes, EBL was 150 cc, and length of stay was 3.0 days. 6 patients (3%) had positive surgical margins. Compared to patients with a BMI < 30, the obesity classes I-III were not associated with any adverse perioperative (OR duration, ischemia time, EBL, LOS) or pathologic (margin status) outcomes.(Table, p for all > 0.05) In a multivariate model querying variables associated with complications, only a RENAL nephrometry ≥ 8 (HR 5.1, 95% CI 2.4-7.9, p<0.001) was significant. CONCLUSIONS An increase in obesity classification was not associated with an adverse perioperative or pathologic outcome related to MIPN. Increasing nephrometry score was the sole variable associated with perioperative complications. The presence of an obese body habitus alone should not preclude offering appropriate patients a MIPN. Association of BMI classification with perioperative and pathologic outcomes of MIPN BMI < 30 BMI 30 - 35 (Class I) BMI 35 - 40 (Class II) BMI > 40 (Class III) p value No. pts. 71 58 33 22 Tumor size (median, cm) 2.5 2.7 3.0 2.7 0.84 Nephrometry score (median) 5.5 7.0 6.0 6.0 0.63 OR duration (median, min) 212 230 207 230 0.34 Ischemia time (median, min) 23.5 24.5 20 25 0.57 EBL (median, cc) 150 175 150 100 0.43 LOS (median, days) 3.0 3.0 3.0 3.0 0.95 Complications (no., %) 21 (30) 16 (28) 11 (33) 5 (23) 0.66 Positive margins (no., %) 4 (6) 0 (0) 1 (3) 1 (5) 0.21 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e674 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Reynolds Hershey, PA More articles by this author Michael Hannon Hershey, PA More articles by this author Kathleen Lehman Hershey, PA More articles by this author Lewis Harpster Hershey, PA More articles by this