Department of Radiology, University of Southern California, Los Angeles, CA, USA.
Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Skeletal Radiol. 2023 Dec;52(12):2469-2477. doi: 10.1007/s00256-023-04371-y. Epub 2023 May 30.
To assess the effect of body muscle and fat metrics on the development of radiologic incisional hernia (IH) following robotic nephrectomy.
We retrospectively reviewed the records of patients who underwent robotic nephrectomy for kidney tumors between 2011 and 2017. All pre- and postoperative CTs were re-reviewed by experienced radiologists for detection of radiologic IH and calculation of the following metrics using Synapse 3D software: cross-sectional psoas muscle mass at the level of L3 and L4 as well as subcutaneous and visceral fat areas. Sarcopenia was defined as psoas muscle index below the lowest quartile. Cox proportional hazard model was constructed to examine the association between muscle and fat metrics and the risk of developing radiologic IH.
A total of 236 patients with a median (IQR) age of 64 (54-70) years were included in this study. In a median (IQR) follow-up of 23 (14-38) months, 62 (26%) patients developed radiologic IH. On Cox proportional hazard model, we were unable to detect an association between sarcopenia and risk of IH development. In terms of subcutaneous fat change from pre-op, both lower and higher values were associated with IH development (HR (95% CI) 2.1 (1.2-3.4), p = 0.01 and 2.4 (1.4-4.1), p < 0.01 for < Q1 and ≥ Q3, respectively). Similar trend was found for visceral fat area changes from pre-op with a HR of 2.8 for < Q1 and 1.8 for ≥ Q3.
Both excessive body fat gain and loss are associated with development of radiologic IH in patients undergoing robotic nephrectomy.
评估人体肌肉和脂肪指标对机器人肾切除术后放射学切口疝（IH）发展的影响。
我们回顾性分析了 2011 年至 2017 年间接受机器人肾切除术治疗肾肿瘤的患者的病历。所有患者的术前和术后 CT 均由经验丰富的放射科医生重新进行了复查，以检测放射学 IH 的发生，并使用 Synapse 3D 软件计算以下指标：L3 和 L4 水平的横截面积腰大肌质量以及皮下和内脏脂肪面积。将肌肉指数低于最低四分位数定义为肌肉减少症。构建 Cox 比例风险模型以检查肌肉和脂肪指标与放射学 IH 发生风险之间的关系。
本研究共纳入 236 例患者，中位（IQR）年龄为 64（54-70）岁。中位（IQR）随访 23（14-38）个月后，62（26%）例患者发生放射学 IH。在 Cox 比例风险模型中，我们未能检测到肌肉减少症与 IH 发展风险之间的关联。就皮下脂肪从术前的变化而言，低值和高值均与 IH 的发生有关（HR（95%CI）2.1（1.2-3.4），p=0.01 和 2.4（1.4-4.1），p<0.01，分别用于 Q1 以下和 Q1 以上）。术前内脏脂肪面积的变化也存在类似的趋势，Q1 以下的 HR 为 2.8，Q1 以上的 HR 为 1.8。
在接受机器人肾切除术的患者中，体重脂肪的过度增加和减少都与放射学 IH 的发生有关。
