Novel Volumetric and Morphological Parameters Derived from Three-dimensional Virtual Modeling to Improve Comprehension of Tumor's Anatomy in Patients with Renal Cancer

被引:15
作者
Bianchi, Lorenzo [1 ,2 ,5 ]
Schiavina, Riccardo [1 ,2 ]
Bortolani, Barbara [3 ]
Cercenelli, Laura [3 ]
Gaudiano, Caterian [4 ]
Mottaran, Angelo [1 ,2 ]
Droghetti, Matteo [1 ,2 ]
Chessa, Francesco [1 ,2 ]
Boschi, Sara [1 ,2 ]
Molinaroli, Enrico [1 ,2 ]
Balestrazzi, Eleonora [1 ,2 ]
Costa, Francesco [1 ,2 ]
Rustici, Arianna [4 ]
Carpani, Giulia [4 ]
Piazza, Pietro [1 ,2 ]
Cappelli, Alberta
Bertaccini, Alessandro [1 ,2 ]
Golfieri, Rita [4 ]
Marcelli, Emanuela [3 ]
Brunocilla, Eugenio [1 ,2 ]
机构
[1] IRCCS Azienda Osped Univ Bologna, Div Urol, Bologna, Italy
[2] Univ Bologna, Bologna, Italy
[3] Univ Bologna, Dept Expt, Lab Bioengn, eDIMES Lab, Bologna, Italy
[4] IRCCS Azienda Osped Univ Bologna, Dept Radiol, Bologna, Italy
[5] IRCCS Azienda Osped Univ Bologna, S Orsola Malpighi Hosp, Div Urol, Bologna, Italy
关键词
Renal cancer; Three-dimensional modeling; Three-dimensional parameters; Robot-assisted partial; nephrectomy; Complications; PARTIAL NEPHRECTOMY; NEPHROMETRY SCORES; COMPLEXITY; OUTCOMES; SURGERY; IMPACT;
D O I
10.1016/j.euf.2021.08.002
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Three-dimensional (3D) models improve the comprehension of renal anatomy.Objective: To evaluate the impact of novel 3D-derived parameters, to predict surgical outcomes after robot-assisted partial nephrectomy (RAPN).Design, setting, and participants: Sixty-nine patients with cT1-T2 renal mass scheduled for RAPN were included. Three-dimensional virtual modeling was achieved from computed tomography. The following volumetric and morphological 3D parameters were calculated: VT (volume of the tumor); VT/VK (ratio between tumor volume and kidney volume); CSA3D (ie, contact surface area); UCS3D (contact to the urinary collecting system); Tumor-Artery3D: tumor's blood supply by tertiary segmental arteries (score = 1), secondary segmental artery (score = 2), or primary segmental/main renal artery (sco-ren = 3); ST (tumor's sphericity); ConvT (tumor's convexity); and Endophyticity3D (ratio between the CSA3D and the global tumor surface).Intervention: RAPN with a 3D model.Outcome measurements and statistical analysis: Three-dimensional parameters were compared between patients with and without complications. Univariate logistic regres-sion was used to predict overall complications and type of clamping; linear regression was used to predict operative time, warm ischemia time, and estimated blood loss.Results and limitations: Overall, 11 (15%) individuals experienced overall complications (7.2% had Clavien >= 3 complications). Patients with urinary collecting system (UCS) involvement at 3D model (UCS3D = 2), tumor with blood supply by primary or secondary segmentary arteries (Tumor-Artery3D = 1 and 2), and high Endophyticity3D values had significantly higher rates of overall complications (all p < 0.03). At univariate analysis, UCS3D, Tumor-Artery3D, and Endophyticity3D are significantly associated with overall complications; CSA3D and Endophyticity3D were associated with warm ischemia time; and CSA3D was associated with selective clamping (all p < 0.03). Sample size and the lack of interobserver variability are the main limits.Conclusions: Three-dimensional modeling provides novel volumetric and morphologi-cal parameters to predict surgical outcomes after RAPN.Patient summary: Novel morphological and volumetric parameters can be derived from a three-dimensional model to describe surgical complexity of renal mass and to predict surgical outcomes after robot-assisted partial nephrectomy.(c) 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:1300 / 1308
页数:9
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