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Novel kidney segmentation system to describe tumour location for nephron-sparing surgery

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Abstract

Purpose

To propose a novel system based on segmental renal anatomy for objectively reporting location of clinical T1 masses for nephron-sparing surgery.

Methods

The kidney was subdivided into 12 standard segments, based on the computed tomography images. In 103 patients (105 cT1 tumours), three blinded radiologists (A, B, and C) prospectively reported segmental tumour location, size, and tumour-feeding arteries. Baseline, peri-operative, and post-operative data of 98 patients who underwent partial nephrectomy (PN) were prospectively collected, and the correlation between segmental tumour location and peri-operative data was evaluated. Kappa statistics were used to measure the inter-observer agreements.

Results

Tumour location could be assigned to the defined renal segment in all cases. Median tumour size was 2.8 cm (range 0.6–5.8). Inter-observer concordance was as follows: A versus B 0.82 (95 % CI 0.74–0.90); A versus C 0.89 (95 % CI 0.83–0.95); and B versus C 0.84 (95 % CI 0.76–0.92). First, second, third, and fourth segments were involved by the tumour in 23, 39, 17, and 21 % of cases, respectively. Number of segments involved by the tumour correlated with tumour size (p = 0.007), number of tumour-feeding arteries (p = 0.001), estimated blood loss during PN (p = 0.03), and trended towards higher post-operative complication rate (p = 0.07). Tumour-feeding arteries were identifiable in 80 patients (76 %).

Conclusions

Kidney segmentation (KS) system is an objective and reproducible radiologic method of universally reporting tumour location according to 12 renal segments. By adding descriptive information on tumour characteristics in candidates for nephron-sparing surgery, this novel KS system could serve as an adjunct to current nephrometry systems.

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Abbreviations

PN:

Partial nephrectomy

KS:

Kidney segmentation

NSS:

Nephron-sparing surgery

FA:

Feeding arteries

EBL:

Estimated blood loss

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

There were de-identified data sharing agreement between both institutions, and the study was IRB-approved from both institutions.

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Authors and Affiliations

  1. Department of Urology, Regina Elena National Cancer Institute of Rome, Via Elio Chinesi, 53, 00144, Rome, Italy

    Rocco Papalia, Giuseppe Simone, Salvatore Guaglianone, Mariaconsiglia Ferriero & Michele Gallucci

  2. Department of Surgical Sciences, “Tor Vergata” University of Rome, Rome, Italy

    Rocco Papalia

  3. Catherine and Joseph Aresty Department of Urology, Institute of Urology, University of Southern California, Los Angeles, CA, 90089, USA

    Andre Luis De Castro Abreu, Scott Leslie, Mihir Desai & Inderbir Singh Gill

  4. Department of Radiology, University “Sapienza”, Rome, Italy

    Valeria Panebianco

  5. Department of Radiology, University of Southern California, Los Angeles, CA, 90089, USA

    Vinay Duddalwar & Tapas Tejura

  6. Laboratory of Molecular Medicine and Biotechnology, Department of Clinical Pathology, University Campus Bio-Medico of Rome, Rome, Italy

    Maunela Costantini

Authors
  1. Rocco Papalia
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  2. Andre Luis De Castro Abreu
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  3. Valeria Panebianco
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  4. Vinay Duddalwar
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  5. Giuseppe Simone
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  6. Scott Leslie
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  7. Salvatore Guaglianone
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  8. Tapas Tejura
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  9. Mariaconsiglia Ferriero
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  10. Maunela Costantini
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  11. Mihir Desai
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  12. Michele Gallucci
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  13. Inderbir Singh Gill
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Corresponding author

Correspondence to Rocco Papalia.

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Papalia, R., De Castro Abreu, A.L., Panebianco, V. et al. Novel kidney segmentation system to describe tumour location for nephron-sparing surgery. World J Urol 33, 865–871 (2015). https://doi.org/10.1007/s00345-014-1386-2

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  • DOI: https://doi.org/10.1007/s00345-014-1386-2

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