The role of three-dimensional model in preoperative communication before partial nephrectomy and postoperative management.

OBJECTIVE: To investigate the role of the three-dimensional (3D) image reconstruction technique in preoperative communication before partial nephrectomy (PN) and postoperative follow-up.

METHODS: A retrospective study was performed with 158 renal cancer patients treated with PN at our center from May 1, 2017 to April 30, 2019. 81 patients (group A) had preoperative communication using the 3D reconstruction technique, while 77 patients (group B) did not. The surgeon explained the anatomical structure, tumor characteristics, and surgical approach in detail to the two groups of patients. Each patient completed a questionnaire. The loss to follow-up rate over a 3-year period was counted for both groups, and non-cancer-related serious complications such as renal failure and cardio-cerebrovascular disease were observed. This research did not include patients who returned for follow-up care owing to associated complications such as postoperative chronic kidney disease. Comparisons between two groups were performed using the Mann-Whitney U test and chi-square test.

RESULTS: All patients showed no statistically significant differences in basic clinical parameters, such as age, gender, body mass index, tumor size, and R.E.N.A.L. score ( P  ​> ​0.05). In group A, patients were significantly more likely to experience understanding of renal anatomy ( P  ​= ​0.001), characteristics of renal cell carcinoma ( P  ​= ​0.003), surgical approach ( P  ​= ​0.007), and relief of preoperative anxiety ( P  ​= ​0.013). The follow-up adherence at 3 years postoperatively in group A and group B was 21 cases and 10 cases, respectively ( P  ​= ​0.041). In addition, glomerular filtration rate < 60 ​mL/min/1.73 ​m2 or serum creatinine > 186 ​μmol/L at 3 years after surgery occurred in 5 patients in group A and 13 in group B ( P  ​= ​0.034), and a systolic blood pressure rise greater than 20 ​mmHg occurred in 9 patients in group A and 18 in group B ( P  ​= ​0.041).

CONCLUSIONS: The use of 3D reconstruction techniques for preoperative communication can successfully improve patients' perception and comprehension of kidney tumors and PN, as well as help to prevent serious postoperative non-cancer-related complications.