Does the Renal Parenchyma Adjacent to the Tumor Contribute to Kidney Function? a Critical Analysis of Glomerular Viability in Partial Nephrectomy Specimens

To evaluate the viability of glomeruli in the peritumor parenchyma of partial nephrectomy (PN) specimens removed for renal cell carcinoma (RCC) and relate it to kidney function, in order to better understand the contribution of peritumor parenchyma to renal function.

A retrospective analysis of 53 PN containing RCC was performed. Glomeruli within 0. 25 cm increments from the tumor were quantified and histologically assessed for viability. Tumor size, minimum/maximum margin size, and pre- and postoperative estimated glomerular filtration rate (eGFR) were obtained.

Glomerular viability positively correlated with distance from tumor with mean viable glomeruli in successive 0. 25 cm increments of 0-0. 25 cm, 58%; 0. 25-0. 5 cm, 80%; 0. 5-0. 75 cm, 90%; and 0. 75-1. 0 cm, 92%. Glomerular viability near the tumor did not correlate with preoperative eGFR while decreased viability further from the tumor did correlate with worse preoperative eGFR. Tumor size showed a nonstatistically significant positive trend with minimum (median 0. 15 cm) and maximum margin (median 0. 7 cm) size. Percent change of GFR did not correlate with margin size (p=0. 190).

Renal parenchyma immediately adjacent to RCC contains fewer viable glomeruli compared to the parenchyma further from tumor. Based on this information, attempts to preserve all non-neoplastic renal parenchyma via a surgical margin approaching zero may not necessarily result in clinically relevant differences in the amount of viable glomeruli remaining or renal function preserved.

Urology. 2015 Oct 23 [Epub ahead of print]

Tariq A Khemees, Elaine T Lam, Amy S Joehlin-Price, Amir Mortazavi, Gary S Phillips, Ahmad Shabsigh, David S Sharp, Debra L Zynger

Department of Urology, The Ohio State University, Columbus, OH. Deparment of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, OH; Department of Internal Medicine, Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO. , Department of Pathology, The Ohio State University, Columbus, OH. , Deparment of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, OH. , Center for Biostatistics, The Ohio State University, Columbus, OH. , Department of Urology, The Ohio State University, Columbus, OH. , Department of Urology, The Ohio State University, Columbus, OH. , Center for Biostatistics, The Ohio State University, Columbus, OH.

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