Effect Of MAP Score On The Outcome Of Semi-course Clamping Laparoscopic Partial Nephrectomy

Background: Renal tumor is still a high incidence tumor of urinary system.Laparoscopic partial nephrectomy（LPN）is often used to manage early stage renal tumors.In LPN,renal artery clamping and unclamping are often involved,resulting in WIT.Semi-course clamping technique,also known as early unclamping technique（EUT）,is used in LPN to reduce warm ischemia time（WIT）.Perirenal fat,including adherent perirenal fat（APF）,often interferes with LPN.The mayo adherent probability（MAP）score can be used to assess the degree of interference of perirenal fat.Objective: To evaluate the effect of MAP score on semi-course clamping LPN and provide the basis for the optimization of partial nephrectomy.Materials and Methods: The clinical data of 137 patients who underwent semi-course clamping LPN between August 2015 and December 2020 in the Second Affiliated Hospital of Anhui Medical University were collected.All patients underwent preoperative enhanced abdominal computed tomography（CT）to obtain MAP scores.Preoperative blood routine,liver and kidney function and other routine examinations were performed,appropriate cases were selected according to the criteria,and estimated blood loss（EBL）,WIT,blood transfusion rate,complications,estimated glomerular filtration rate（e GFR）,Serum creatine（Scr）and other conditions were recorded.To evaluate the safety of semi-course clamping LPN under different MAP scores as well as the surgical effect.Among them," Trifecta" after LPN and " Pentafecta" after LPN participated in the deeper assessment of semi-course clamping LPN.Results:（1）Of the 137 patients,97 were male and 40 were female,with aged（58.05±12.38）years,,21 had diabetes,53 had hypertension,71 had left tumor and 66 had right tumor,with BMI of（25.65 ± 3.05）and maximum tumor diameter of（3.82 ± 1.19）cm.Of these,99 were in the low MAP score group and 38 were in the high MAP score group.（2）EBL was lower（P < 0.001）,operation time（P = 0.033）and WIT（P = 0.001）in the low MAP score group than in the high MAP score group.There was no difference in pathological findings between the low MAP score group and the high MAP score group（P = 0.944）.（3）There was no significant difference in complications between the low MAP score group and the high MAP score group（P = 0.554）.The blood transfusion rate in the high MAP score group（7.89%）was higher than that in the low MAP score group（2.02%）,but there was no significant difference（P = 0.101）.（4）There was no statistically significant difference in preoperative Scr（P = 0.567）,preoperative e GFR（P= 0.759）,postoperative Scr（P = 0.176）,and postoperative e GFR（P = 0.126）between the two groups.（5）There was no difference in the achievement of the " Trifecta " goal between the two groups（P = 0.223）,but the achievement rate of the " Pentafecta " goal was lower in the high MAP score group（47.37%）than in the low MAP score group（68.69%）（P = 0.021）.Conclusion: Different MAP scores have different effects on the results of semi-course clamping LPN.High MAP leads to prolonged operation time and WIT for semi-course clamping LPN,prompting increased EBL.Semi-course clamping technique can still be applied under high MAP score,and high MAP score does not necessarily affect the occurrence of postoperative complications after semi-course clamping LPN.High MAP scores did not reduce the occurrence of " Trifecta " of semi-course clamping LPN,but the reduction reduced the achievement rate of " Pentafecta " after PN.