Senel Samet, Koudonas Antonios, Sandikci Fatih, Rassweiler Jens
Department of Urology, Ankara City Hospital, Universiteler Mahallesi 1604. Cadde No: 9 Cankaya/Ankara/Turkiye, Ankara, Turkey.
School of Medicine, First Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
BMC Urol. 2025 May 29;25(1):141. doi: 10.1186/s12894-025-01826-3.
Adherent perinephric fat (APF) represents a clinical situation, which increases the complexity of renal surgery. We aimed to elucidate the common characteristics of patients with APF and to evaluate the extent of outcome differentiation depending on the presence of APF.
We made a retrospective review of a prospectively maintained database of patients who underwent laparoscopic retroperitoneal partial nephrectomy for a localized renal tumor at our institution from May 2010 to January 2022. 238 patients were included in this study. Demographic, intraoperative, postoperative data and characteristics and comorbidities of all patients were evaluated. Radiographic data (tumor size, localization, side, exophytic rate, perinephric fat density [PFD]) were determined from preoperative contrast-enhanced abdominal computed tomography imaging studies. Adherent perinephric fat was classified intraoperatively by the operating surgeon. The patients were divided into two groups as the APF group and the non-APF group and predictors causing APF were investigated.
Intraoperative and postoperative complication rates were higher in the APF group, but the difference between intraoperative complication rates, operation duration and amount of bleeding were statistically significant. (11.6% vs. 5.9%, p = 0.033; 130 vs. 120 min, p = 0.024; 60 vs. 30 cc, p = 0.016, respectively). The most common complications were conversion to open surgery due to failure of dissection of the tumor and bleeding requiring intraoperative transfusion in the groups. On multivariable analysis using stepwise regression model, we identified male gender (OR = 3.328; 95% Cl = 1.552-7.133; p = 0.002), PFD>-100.4 Hounsfield Unit (HU) (OR = 3.24; 95% Cl = 1.549-6.777; p = 0.002) and presence of diabetes mellitus (DM) (OR = 2.513; 95% Cl = 1.192-5.299; p = 0.015), as predictor of APF.
Male gender, presence of DM and PFD>-100.4 HU are predictors of APF. This endpoint is promising for application in gaining knowledge preoperatively about the dissection difficulty level.
肾周粘连脂肪（APF）代表一种临床情况，它增加了肾脏手术的复杂性。我们旨在阐明APF患者的共同特征，并评估根据APF的存在情况结果差异的程度。
我们对2010年5月至2022年1月在本机构接受腹腔镜腹膜后肾部分切除术治疗局限性肾肿瘤的患者的前瞻性维护数据库进行了回顾性研究。本研究纳入了238例患者。评估了所有患者的人口统计学、术中、术后数据以及特征和合并症。术前对比增强腹部计算机断层扫描成像研究确定影像学数据（肿瘤大小、定位、侧别、外生性率、肾周脂肪密度[PFD]）。术中由手术医生对肾周粘连脂肪进行分类。将患者分为APF组和非APF组，并调查导致APF的预测因素。
APF组的术中及术后并发症发生率较高，但术中并发症发生率、手术时间和出血量之间的差异具有统计学意义。（分别为11.6%对5.9%，p = 0.033；130对120分钟，p = 0.024；60对30毫升，p = 0.016）。最常见的并发症是两组中因肿瘤剥离失败而转为开放手术以及术中需要输血的出血。在使用逐步回归模型的多变量分析中，我们确定男性（OR = 3.328；95%CI = 1.552 - 7.133；p = 0.002）、PFD > -100.4亨氏单位（HU）（OR = 3.24；95%CI = 1.549 - 6.777；p = 0.00002）和糖尿病（DM）的存在（OR = 2.513；95%CI = 1.192 - 5.299；p = 0.015）为APF的预测因素。
男性、DM的存在和PFD > -100.4 HU是APF的预测因素。这一终点对于术前了解解剖难度水平具有应用前景。
