Analysis of Factors Influencing Mayo Adhesive Probability Score in Partial Nephrectomy

Evaluating the adherent perinephric fat risk score in East Asian populations and its correlation with non-alcoholic fatty liver disease

BACKGROUND AND AIMS

This study evaluated the predictive value of the APF risk score in East Asian patients undergoing open nephrectomy and its correlation with hypertension and NAFLD.

METHODS AND RESULTS

A retrospective study used the clinical data of 82 patients who underwent ON between January 2010 and December 2022. Per their APF score, patients were categorized into groups A (0-2 points) and B (3-4 points). Logistic regression analyses were used to compare the overall clinical data between the two groups and identify potential risk factors. Intraoperative APF prevalence was significantly higher in group B compared to group A (P < 0.001). Group B patients were older (63.06 ± 8.88 vs. 53.69 ± 15.21 years) and had higher incidences of hypertension (P < 0.001), diabetes (P = 0.002), and NAFLD (P < 0.001). Preoperative CT scans showed significant differences in posterior (P = 0.009) and lateral perinephric fat thickness (P < 0.001), and perinephric stranding (P < 0.001). Group B also had a higher proportion of malignant tumors (P = 0.039). Multivariate logistic regression revealed that NAFLD (OR = 9.053, P = 0.010) and hypertension (OR = 5.181, P = 0.025) were highly correlated with APF risk scores.

CONCLUSIONS

In this study, we found that the newly developed APF risk score had significant value in predicting APF in East Asian patients undergoing open nephrectomy. Additionally, NAFLD and hypertension were highly correlated with elevated APF risk scores.

Analysis of Clinical Characteristics, Radiological Predictors, Pathological Features, and Perioperative Outcomes Associated with Perinephric Fat Adhesion Degree

Background

To assess the clinical characteristics, radiological predictors, and pathological features of perinephric fat adhesion degree (PFAD) graded based on fixed criteria and to determine the impact of adherent perinephric fat (APF) on retroperitoneal laparoscopic partial nephrectomy (RLPN) outcomes.

Methods

84 patients undergoing RLPN were included and graded into 4 groups based on PFAD. Univariate and multivariate analyses were performed for clinical characteristics and radiological predictors of PFAD. Perioperative data were compared between APF groups and non-APF groups. Masson staining determined collagen fibers. Immunohistochemistry detected CD45 immune cells and CD34 vessels.

Results

20, 28, 18, and 18 patients were graded as normal perinephric fat (NPF), mild adherent perinephric fat (MiPF), moderate adherent perinephric fat (MoPF), and severe adherent perinephric fat (SPF), respectively. Multivariate analysis revealed that gender (p < 0.001), age (p = 0.003), and hypertension (p = 0.006) were significant clinical risk factors of PFAD, while radiological predictors included perinephric stranding (p = 0.001), posterior perinephric fat thickness (p = 0.009), and perinephric fat density (p = 0.02). APF was associated with drain output (p = 0.012) and accompanied by immune cells gathering in renal cortex near thickened renal capsule with many vessels.

Conclusions

Clinical characteristics and radiological predictors can evaluate PFAD and may assist to guide preoperative surgical option. Pathological features of APF reflect decapsulation and bleeding during kidney mobilization at RLPN.

Multislice Spiral CT Image Analysis and Meta-Analysis of Inspiratory Muscle Training on Respiratory Muscle Function

Respiratory muscle function has a significant effect on stroke. Stroke is one of the most common cardiovascular and cerebrovascular diseases in the clinic and has a significant impact on the quality of life of patients. Hemiplegia, cerebral hemorrhage, and even death can occur, mainly in the elderly. In this paper, we meta-analyzed the effect of inspiratory muscle training on respiratory muscle function. In this article, we used a topic search method to search for relevant literature on respiratory muscle training and obtained 58 and 32 literature studies from CNKI and Wanfang Data, respectively. As a result of the screening, 36 and 28 documents were obtained. In this paper, 64 selected articles were studied. The authors make statistics on the literature of designing serum content index and multislice spiral CT (Member of the Society of Cardiological Technicians) image of patients, so as to analyze the influence of CT image and inspiratory muscle training on respiratory muscle function. The study showed that FVC, FEV1, MIP, and diaphragm mobility of the experimental group were significantly improved after treatment in more than 85% of the studies (P < 0.05), while those of the control group were not significantly improved (P > 0.05). The comparison between the two groups after treatment showed that FVC, FEV1, MIP, and diaphragm mobility of the experimental group were higher than those of the control group (P < 0.05). The application of multislice spiral CT image analysis technology can effectively evaluate the effect of inspiratory muscle training on respiratory dysfunction in stroke patients, the mechanism of which regulates the expression of related pathways, suppresses the inflammatory response, and can reduce oxidative stress damage. Therefore, respiratory muscle training can improve the function of respiratory muscle and reduce the death rate of cerebellar hemorrhage in patients with stroke and other vascular diseases.

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-assisted PN. 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.

Correlation Between the Mayo Adhesive Probability Score and the Operative Time in Laparoscopic Donor Nephrectomy

BACKGROUND

Adherent perinephric fat (APF) is a known risk factor of surgical difficulty during laparoscopic donor nephrectomy (LDN). The Mayo Adhesive Probability (MAP) score predicts APF accurately. The aim of this study is to identify the association between MAP score and operative time in LDN.

METHODS

We retrospectively evaluated 154 kidney donors who underwent surgery from December 2017 to December 2019 at İstanbul Aydın University Hospital and İstinye University Hospital. All of the operations were done by 3 senior surgeons by a fully laparoscopic method. The MAP score was derived from computed tomography scans by 1 blinded reader. Demographic data, body mass index (BMI), MAP score, side selection, estimated glomerular filtration rate (eGFR), number of arteries and veins, operative time, hospital stay, and complications are recorded. Single and multiple variable analyses were used to evaluate the correlation between operative time and MAP score, BMI, side selection, and number of vascular structures.

RESULTS

A total of 154 patients (79 men, 75 women) with a mean age of 44.4 ± 12.72 were included in this study. None of the cases were converted to open nephrectomy. There were no major complications. Mean BMI was 27.59 ± 4.32 kg/m², mean MAP score was 0.69 ± 1.15, and mean operative time was 40.25 ± 9.81 minutes. Although mean BMI was higher in women (28.19 ± 4.52 vs 27.03 ± 4.07; P < .05), mean MAP score was lower than in men (0.35 ± 0.86 vs 1.03 ± 1.29; P < .001). Older age, higher BMI, higher MAP score, and presence of multiple renal arteries were associated with longer operative time of LDN. The MAP score was associated with older age, male sex and higher BMI.

CONCLUSIONS

This study showed that different risk factors can affect operative time in LDN. The MAP score was significantly associated with longer operative time, especially in men, so it can be useful for predicting surgical difficulty in kidney donors.

Mayo Adhesive Probability (MAP) score of non-donated kidney aids in predicting post-operative renal function following donor nephrectomy

Background

To examine the association of preoperative Mayo Adhesive Probability (MAP) scores in the donor (MAP_d) and non-donor kidneys (MAP_nd) with post-donation renal function.

Methods

Three hundred thirty-one patients undergoing hand assisted laparoscopic donor nephrectomy (HALDN) were reviewed. MAP_d and MAP_nd were obtained. Estimated glomerular filtration rate (eGFR) was recorded preoperatively and at 1 day, 1 month, and 6 months postoperatively.

Results

Two hundred females and 131 males were evaluated with median BMI 26.4 kg/m² (range 17.1–39.6) and median age 45 years (range 19–78). MAP_d score was 0 for 231 patients (69.8%) and > 0 for 100 patients (30.2%). MAP_nd score was 0 for 234 patients (70.7%) and > 0 for 97 patients (29.3%). The median preoperative eGFR was 86.6 ml/min/1.73m² (range 48.8–138.4). After adjusting for preoperative eGFR, BMI, ASA score, and kidney sidedness, postoperative eGFR was associated with MAP score in the non-donated kidney (p = 0.014) but not in the donated kidney (p = 0.24). Compared to donors with MAP_nd = 0, donors with a MAP_nd > 0, mean eGFR was − 2.33 ml/min/1.73m² lower at postoperative day 1 (95% CI − 4.24 to − 0.41, p = 0.018), − 3.02 ml/min/1.73m² lower at 1 month (95% CI − 5.11 to − 0.93, p = 0.005), and − 2.63 ml/min/1.73m² lower at 6 months postoperatively (95% CI − 5.01 to − 0.26, p = 0.030).

Conclusions

MAP score > 0 in the non-donated kidney is associated with worse renal function in the 6 months following HALDN.

The Mayo Adhesive Probability Score Predicts Longer Dissection Time During Laparoscopic Partial Nephrectomy

Background: To examine the impact of the Mayo adhesive probability (MAP) score on the surgical complexity of exposing the tumor during laparoscopic partial nephrectomy (LPN). Patients and Methods: Our study included 318 patients who underwent LPN from January 2017 to December 2018 at our institution. Patients were divided into a lower MAP score group (≤2, n = 172) and a higher MAP score group (≥3, n = 146). Perioperative outcomes were compared between the groups. The operative time was predominantly occupied by the dissection time and the warm ischemia time (WIT). Results: A higher MAP score was associated with a longer operative time (131 vs 110 minutes, p < 0.001) and longer dissection time (71 vs 54 minutes, p < 0.001), respectively. The estimated blood loss (EBL) increased in patients with a higher MAP score (50 vs 20 mL, p < 0.001). No significant difference was found with respect to the WIT (21 vs 20 minutes, p = 0.370). In the multivariate linear regression model, male gender (β = 11.199, p = 0.001), body mass index (β = 1.197, p = 0.008), and MAP score (β = 9.958, p = 0.002) were significantly associated with the prolongation of dissection time. Conclusions: The MAP score was significantly associated with the prolongation of dissection time during LPN. In addition, the EBL increased in patients with a higher MAP score. Therefore, the MAP score can predict surgical complexity of exposing the tumor in patients undergoing LPN.

Risk Factors Influencing the Thickness and Stranding of Perinephric Fat of Mayo Adhesive Probability Score in Minimally Invasive Nephrectomy

Background

Mayo adhesive probability (MAP) score, an accurate and reliable predictor of adherent perinephric fat (APF), consists of posterior perinephric fat thickness and perinephric fat stranding. The present study aimed to identify the potential clinical characteristics associated with these 2 variables to further our understanding of APF.

Material/Methods

Clinical data of 346 patients subjected to minimally invasive nephrectomy was collected within our prospectively maintained database, between January 2015 and December 2016. Radiological data was assessed by 2 readers in an independent blinded – to each other and APF patient status – fashion. Ordinal logistic regression analyses were performed to evaluate risk factors of posterior perinephric fat thickness and perinephric fat stranding.

Results

On multivariate analysis, posterior perinephric fat thickness was associated with older age (b=1.05 [range, 1.03–1.07], P<0.01); male gender (b=6.06 [3.18–11.54], P<0.01), and higher body mass index (BMI) (b=1.31 [1.21–1.41], P<0.01). Perinephric fat stranding was associated with older age (b=1.05 [1.02–1.07], P<0.01), male gender (b=3.64 [2.09–6.34], P<0.01) and history of diabetes (b=2.09 [1.24–3.52], P<0.01). MAP score was associated with older age (b=1.05 [1.03–1.07], P<0.01), male gender (b=5.07 [2.96–8.71], P<0.01), higher BMI (b=1.14 [1.07–1.21], P<0.01), history of diabetes (b=1.72 [1.06–2.78], P=0.03) and alcoholism (b=1.88 [1.10–3.20], P=0.02).

Conclusions

The current study highlights that different risk factors influence the posterior perinephric fat thickness and perinephric fat stranding. Posterior perinephric fat thickness was correlated with age, gender, and BMI, while perinephric fat stranding was associated with age, gender, and history of diabetes.