Increased Intra-abdominal Fat Predicts Perioperative Complications Following Minimally Invasive Partial Nephrectomy

• Published in: Urology (Ridgewood, N.J.) N.J.), 2013-06, Vol.81 (6), p.1225-1231
• Main Authors: Gorin, Michael A, Mullins, Jeffrey K, Pierorazio, Phillip M, Jayram, Gautam, Allaf, Mohamad E
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Body Mass Index; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Confidence Intervals; Female; Humans; Intra-Abdominal Fat; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Laparoscopy - adverse effects; Length of Stay; Male; Medical sciences; Metabolic diseases; Middle Aged; Multivariate Analysis; Nephrectomy - adverse effects; Nephrology. Urinary tract diseases; Obesity; Odds Ratio; Operative Time; Postoperative Complications - classification; Postoperative Complications - etiology; Predictive Value of Tests; Retrospective Studies; Risk Factors; Robotics; Subcutaneous Fat, Abdominal; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2012.12.053

Objective To evaluate the anthropometric measurements of body mass index, outer-abdominal fat (OAF) and intra-abdominal fat (IAF) for their utility in predicting perioperative complications following minimally invasive partial nephrectomy. Methods We retrospectively reviewed the clinical data of patients who underwent a laparoscopic or robotic partial nephrectomy between August 2006 and July 2012 by a single surgeon. Measurements of OAF and IAF were obtained from preoperative cross-sectional imaging available through our institution's imaging archive. Preoperative clinical parameters, including BMI, OAF and IAF, were evaluated for associations with postoperative complications, operative time and length of hospital stay. Results In total, 257 patients underwent a minimally invasive partial nephrectomy during the study period. Of these patients, 195 (75.9%) had preoperative scans available for analysis of OAF and IAF. A total of 52 (26.7%) patients experienced a Clavien grade I-IV complication within 30 days of surgery, 18 (34.6%) of which were grade III-IV. No patient experienced a grade V complication. On multivariate analysis, only increasing IAF (OR 1.05 [95% CI 1.02-1.09], P  = .005) was associated with grade I-IV complications, while IAF (OR 1.05 [95% CI 1.00-1.10], P  = .04) and intermediate to high tumor complexity (OR 5.31 [95% CI 1.47-19.17], P  = .01) were associated with grade III-IV complications. BMI, OAF and IAF were not found to be independently associated with operative time or length of hospital stay. Conclusion IAF is independently associated with complications following minimally invasive partial nephrectomy. With further validation, this measurement may prove useful in the preoperative risk stratification of patients with small renal masses.