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. 2022 Oct 21:12:1046505.
doi: 10.3389/fonc.2022.1046505. eCollection 2022.

3D renal model for surgical planning of partial nephrectomy: A way to improve surgical outcomes

Lorenzo Bianchi  1   2 , Laura Cercenelli  3 , Barbara Bortolani  3 , Pietro Piazza  1 , Matteo Droghetti  1 , Sara Boschi  1 , Caterina Gaudiano  4 , Giulia Carpani  4 , Francesco Chessa  1   2 , Simone Lodi  3 , Lorenzo Tartarini  3 , Alessandro Bertaccini  1   2 , Rita Golfieri  4 , Emanuela Marcelli  3 , Riccardo Schiavina  1   2 , Eugenio Brunocilla  1   2
Affiliations

3D renal model for surgical planning of partial nephrectomy: A way to improve surgical outcomes

Lorenzo Bianchi et al. Front Oncol. .

Abstract

Objective: to evaluate the impact of 3D model for a comprehensive assessment of surgical planning and quality of partial nephrectomy (PN).

Materials and methods: 195 patients with cT1-T2 renal mass scheduled for PN were enrolled in two groups: Study Group (n= 100), including patients referred to PN with revision of both 2D computed tomography (CT) imaging and 3D model; Control group (n= 95), including patients referred to PN with revision of 2D CT imaging. Overall, 20 individuals were switched to radical nephrectomy (RN). The primary outcome was the impact of 3D models-based surgical planning on Trifecta achievement (defined as the contemporary absence of positive surgical margin, major complications and ≤30% postoperative eGFR reduction). The secondary outcome was the impact of 3D models on surgical planning of PN. Multivariate logistic regressions were used to identify predictors of selective clamping and Trifecta's achievement in patients treated with PN (n=175).

Results: Overall, 73 (80.2%) patients in Study group and 53 (63.1%) patients in Control group achieved the Trifecta (p=0.01). The preoperative plan of arterial clamping was recorded as clampless, main artery and selective in 22 (24.2%), 22 (24.2%) and 47 (51.6%) cases in Study group vs. 31 (36.9%), 46 (54.8%) and 7 (8.3%) cases in Control group, respectively (p<0.001). At multivariate logistic regressions, the use of 3D model was found to be independent predictor of both selective or super-selective clamping and Trifecta's achievement.

Conclusion: 3D-guided approach to PN increase the adoption of selective clamping and better predict the achievement of Trifecta.

Keywords: 3D model; partial nephrectomy; renal cancer; surgical outcomes; surgical planning.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of participants in the study.
Figure 2
Figure 2
(A) Causes of Trifecta’s failure in patients underwent PN in Study group who did not reach the Trifecta (n=18/91); (B) Causes of Trifecta’s failure in patients underwent PN in Control group who did not reach the Trifecta (n=31/84).
Figure 3
Figure 3
(A) Surgical planning of scheduled PN based on 2D imaging; (B) After revision of 3D model the planning of surgery was converted to RN before surgery, due to suspicious invasion of urinary collecting system and renal sinus.
Figure 4
Figure 4
(A) Selective clamping of primary arterial branching (arrows in axial/coronal views and in 3D rendering), resulting from preoperative planning based on standard 2D CT imaging; (B) Super-selective clamping of tertiary arterial branching (arrow), resulting from preoperative planning based on 3D model.
See this image and copyright information in PMC

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