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Volume 15
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10.3390/jcm15176884
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Adherent Perinephric Fat and Positive Surgical Margin in Laparoscopic Partial Nephrectomy: A Technique-Conditional Association Concentrated in Enucleation

by
Abdurrahman İnkaya
1,*,
Hasan Samet Güngör
1,
Ahmet Şanlı
2,
Mehmet Sencer Sözen
1,
Mehmet Umut Evci
1,
Ali Kumcu
3,
Serhat Göçer
3,
Ümit Yıldırım
4,
Murat Beyatlı
1,
Cemil Emre Yurtseven
1,
Abdullah Esmeray
1,
Ferhat Yakup Suçeken
1,
Ahmet Tahra
1,
Resul Sobay
1 and
Eyüp Veli Küçük
1
1
Department of Urology, Umraniye Training and Research Hospital, Istanbul 34764, Türkiye
2
Urology Department, Karamanoglu Mehmetbey University Training and Research Hospital, Karaman 70100, Türkiye
3
Department of Urology, Tekirdag City Hospital, Tekirdag 59030, Türkiye
4
Department of Urology, Kafkas University Training and Research Hospital, Kars 36100, Türkiye
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(17), 6884; https://doi.org/10.3390/jcm15176884
Submission received: 26 June 2026 / Revised: 3 August 2026 / Accepted: 4 September 2026 / Published: 5 September 2026
(This article belongs to the Special Issue Kidney Cancer: From Diagnostic to Therapy—2nd Edition)
Versions Notes

Abstract

Background/Objectives: Adherent perinephric fat (APN) is common in laparoscopic partial nephrectomy (LPN). It is absent from the lists of recognised positive surgical margin (PSM) predictors. We tested whether APN is associated with PSM risk and whether the effect varies by resection technique. Methods: We analysed 401 International Society of Urological Pathology (ISUP)-gradable renal cell carcinomas (31 PSM events; chromophobe RCC was excluded from the primary cohort because the WHO/ISUP grade is not assignable) carried out at three centres by eight surgeons from 2013 to 2024. Nested logistic models added APN, then an APN × enucleation interaction, to a guideline-based covariate set (tumour size, ISUP grade ≥ 3, cT1b stage, centre fixed effects, surgeon-documented enucleation). Firth penalisation and a 2000-replicate bootstrap were used to limit small-sample bias; they cannot add information beyond the 31 observed events. Results: APN was an independent PSM predictor (adjusted odds ratio [OR] 2.68, 95% confidence interval [CI] 1.21 to 5.95, p = 0.02). The effect was technique-conditional: APN × enucleation interaction OR 7.83 (95% CI 1.08 to 56.92, p = 0.04), consistent in direction across estimators but imprecise in magnitude. PSM occurred in 29.4% of APN-positive enucleation cases (odds ratio 10.21, 95% CI 2.07 to 50.30; Fisher exact p = 0.003), against 5.0% in enucleoresection and 10.8% in resection. Conclusions: In this cohort the APN-to-PSM association was technique-conditional. The penalty concentrates in enucleation; the rim-retaining strata gave estimates compatible with both no association and clinically important harm (OR 0.99 and 1.96, both intervals wide). Because the interaction rests on few margin events and the technique was not randomised, this finding is hypothesis-generating: when APN is encountered intraoperatively, retaining a parenchymal rim (enucleoresection or resection) rather than enucleation may be considered, pending prospective validation.
Keywords: partial nephrectomy; laparoscopy; surgical margins; adherent perinephric fat; nephrometry score; tumour enucleation partial nephrectomy; laparoscopy; surgical margins; adherent perinephric fat; nephrometry score; tumour enucleation

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MDPI and ACS Style

İnkaya, A.; Güngör, H.S.; Şanlı, A.; Sözen, M.S.; Evci, M.U.; Kumcu, A.; Göçer, S.; Yıldırım, Ü.; Beyatlı, M.; Yurtseven, C.E.; et al. Adherent Perinephric Fat and Positive Surgical Margin in Laparoscopic Partial Nephrectomy: A Technique-Conditional Association Concentrated in Enucleation. J. Clin. Med. 2026, 15, 6884. https://doi.org/10.3390/jcm15176884

AMA Style

İnkaya A, Güngör HS, Şanlı A, Sözen MS, Evci MU, Kumcu A, Göçer S, Yıldırım Ü, Beyatlı M, Yurtseven CE, et al. Adherent Perinephric Fat and Positive Surgical Margin in Laparoscopic Partial Nephrectomy: A Technique-Conditional Association Concentrated in Enucleation. Journal of Clinical Medicine. 2026; 15(17):6884. https://doi.org/10.3390/jcm15176884

Chicago/Turabian Style

İnkaya, Abdurrahman, Hasan Samet Güngör, Ahmet Şanlı, Mehmet Sencer Sözen, Mehmet Umut Evci, Ali Kumcu, Serhat Göçer, Ümit Yıldırım, Murat Beyatlı, Cemil Emre Yurtseven, and et al. 2026. "Adherent Perinephric Fat and Positive Surgical Margin in Laparoscopic Partial Nephrectomy: A Technique-Conditional Association Concentrated in Enucleation" Journal of Clinical Medicine 15, no. 17: 6884. https://doi.org/10.3390/jcm15176884

APA Style

İnkaya, A., Güngör, H. S., Şanlı, A., Sözen, M. S., Evci, M. U., Kumcu, A., Göçer, S., Yıldırım, Ü., Beyatlı, M., Yurtseven, C. E., Esmeray, A., Suçeken, F. Y., Tahra, A., Sobay, R., & Küçük, E. V. (2026). Adherent Perinephric Fat and Positive Surgical Margin in Laparoscopic Partial Nephrectomy: A Technique-Conditional Association Concentrated in Enucleation. Journal of Clinical Medicine, 15(17), 6884. https://doi.org/10.3390/jcm15176884

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