Assessment of Patient-Related Operative Complexity During Partial Nephrectomy: Comparison of Two Tailored Methods for Measurement of Posterior Perinephric Fat Thickness on Preoperative CT

Background: Adherent perinephric fat affects operative complexity during partial nephrectomy (PN) and it could be predicted using computed tomography (CT) based on the Mayo adhesive probability (MAP) score. Objectives: To investigate reproducible measurement methods of perinephric fat with comparison of two tailored methods for measurement of posterior perinephric fat thickness (PPFT) on preoperative CT and examine the association between the methods and operative complexity in PN. Patients and Methods: This cross-sectional study included 72 consecutive patients who underwent robotic-assisted or open PN. The data on operative time, ischemia time, and pathologic results were obtained. Two radiologists independently assessed PPFT based on the MAP system in the first session, and subsequently by using two tailored methods in the second session and scored for perinephric fat stranding. The nephrometry scoring system was used for stratifying the complexity of renal masses. Multiple linear regression was used to evaluate the determinants of operative time and ischemia time. Results: For measurement of PPFT, intraclass correlation coefficients between the reviewers using two detailed methods showed no statistical difference (P = 0.173) but were significantly higher than the coefficients scored in the first session (P 0.001). Nephrometry score was a determinant of ischemia time (P 0.001 and 0.001 for two reviewers) and PPFT was identified as a determinant of operative time (P 0.023 in all the analysis using two different methods for both the reviewers) in robotic-assistedPN. Nephrometry score was identified as a determinant of ischemia time in open PN as per one of the reviewers (P = 0.006). Conclusion: The tailored methods presented herein were more reproducible than the MAP score and demonstrated that increased PPFT was related to longer operative time in robotic-assisted, and not in open PN.