The Effect Of APF On Peri-operative Outcomes Of Laparoscopic Parti Al Nephrectomy And Prospective Assessment Of Predictors Of APF

Objective:Aderent perirenal fat(APF)increases the complexity of laparoscopic partial nephrectomy,especially the difficulty of dissection and exposure of the tumor.Our objective was to evaluate the effect of APF on peri-operative outcomes of laparoscopic partial nephrectomy and prospective assessment of predictors of APF.Methods: we analysed the data of 198 patients who underwent LPN for a small renal tumor in the Qingdao City Hospital affiliated to Qingdao University from January 2015 to January 2019.According to the preoperative CT imageing,operation record and surgical video,the patients were divided into two groups,the APF group and the no APF group.We collceted the age,sex,ASA grade,BMI,tumor maximum diameter,tumor location,MPA score,preoperative creatinine,,preoperative eGFR,triglyceride,RENAL score,PADUA score,and presence or absence of hypertension with diabetes.Surgical time,warm ischemia time,intraoperative blood loss,hospital stay,postoperative complications were also collected.Chi-square test and t-test were used to analyze the effect of aderent perirenal fat on peri-operative period.The predictive factor analysis of APF is analyzed by univariate analysis and multivariate analysis.Results:In the AFP group,operative time was longer(148.70±10.34 min VS120 。06±9.32 min P<0.001)and EBL was higher(149.80±10.45 ml VS99.82±9.36 ml P<0.001),BMI was also higer(26.74±3.74 kg/m2 VS 25.44±3.74kg/m2 P=0.0268)and the age was older(61.20±7.91 y VS 58.76±5.23 y,P=0.0096)There were a high proportion of men(80.00%VS57.72%,P=0.001),patients with hypertension(28.00%VS13.82%,P=0.014),patients with diabetes(36.00%VS22.76%,P=0.044),and patients with hyperlipemia(31.8%VS 18.7%,P=0.007).Also,the patients of conversion to open surgery are more in APF group and they have more MAP score(3.51±1.17VS1.87±0.96,P<0.001).The composition ratio of side of the tumor(P=0.773),ASA classification(P=0.055),RENAL score(P=0.352)is similar.But the tumor size(31.36±4.83 mm VS30.34±4.90 mm,P=0.1554),warm ischaemia time(25.10±1.79 min VS 25.07±1.77 min P=0.9145),Length of stay(11.20±2.27 d VS 10.76±2.48 d P=0.1993),Preoperative creatinine(74.10±23.57umol/L VS70.03±18.93umol/L,P=0.1834),Postoperativecomplications(32.05%VS25.20%,P=0.218),Postoperative creatinine of thirty days(83.28±19.19umol/L VS 80.63±14.13umol/L P=0.2670)were similar.In the univariate analysis we found BMI(OR=1.09,P=0.029),Sex(OR=2.93,P=0.002),age(OR=1.06,P=0.011),dyslipidemia(OR=3.82,P<0.001)),diabetes(OR=1.91,P=0.045),hypertension(OR=2.42,P=0.016),MAP score(OR=2.50,P<0.001)is the predictive factor of APF for APF,but In multivariate analysis,only gender(OR=3.30,P=0.008),MAP score(OR=3.30,P<0.001)is still a predictor of APF.Conclusion:APF can increase the operation time and intraoperative blood loss,but does not increase the warm ischemia time.The predictors of APF are MAP scores and age,which can help clinicians predict the complexity of surgery.