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Renal malignancy and peritumor fat: is it necessary to send perinephric fat for pathology during partial nephrectomy?
Didi Theva, MD, Liz Wang, BA, Gabriella Avellino, MD, Mark Katz, MD, Richard Babayan, MD, David Wang, MD.
Boston Medical Center, Boston, MA, USA.

Introduction:
Nephron-sparing surgery is being used increasingly for renal malignancy. Peri-nephric fat is routinely sent as a separate specimen for staging purposes by the surgeon. Our aim is to determine the prevalence of peritumor fat involvement per tumor stage.
Methods:
We retrospectively reviewed partial nephrectomies, performed open, laparoscopic, or robotically between 2011 and 2015.
Results
Of 157 partial nephrectomies performed by two surgeons, 127 (80.9%) resulted with malignancy as final pathology, of which 98 (77.2%) had perinephric fat sent for pathology. Of these cases with fat sent, the majority were clear cell with 69 patients (70.4%), second most common being papillary with 22 patients (22.4%). Tumor grade ranged from T1a with 59 patients (60.2%), T1b with 34 (34.7%), and 5 patients with T2 grade (5.1%). Of those, no patients were found to have involvement of peritumor fat. There were no cases of perinephric fat being positive for renal cell carcinoma.
Conclusions:
In the case when nephron-sparing surgery is used for renal malignancy, peritumor fat is often sent. In our series of patients, with pathology ranging from T1a-T2a, peritumor fat pathology has been routinely negative. Though surgeons often send this fat for pathological analysis, this study suggests that this is unnecessary.


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