The role of hyperaccuracy CT three-dimensional reconstruction technology in partial nephrectomy for completely endophytic renal cell carcinoma: A retrospective propensity-matched cohort study.

Background: To compare the clinicopathological, perioperative, functional, and oncological outcomes of completely endophytic renal cell carcinoma (RCC) patients who underwent partial nephrectomy (PN) with or without preoperative hyperaccuracy CT three-dimensional (HACT3D) reconstruction.

Methods: A retrospective cohort study was conducted on 154 completely endophytic RCC patients treated with PN at our medical center from January 2018 to December 2023. Patients were divided into two groups based on whether they received preoperative HACT3D reconstruction. To control for selection bias, we implemented 1:1 propensity score matching based on baseline characteristics.

Results: In the original cohort, 47 patients in the HACT3D group had higher RENAL scores (P = 0.014) and PADUA scores (P = 0.012). After matching, each group contained 47 RCC patients with no significant baseline differences (P > 0.05). In the matched cohort, patients in the HACT3D group had significantly shorter warm ischemia time (WIT) (22.3 vs. 26.7 min, p < 0.001), shorter total length of hospital stay (LOS) (10.0 vs. 11.6 days, p = 0.012), shorter postoperative LOS (5.8 vs. 7.3 days, p = 0.003), and higher trifecta achievement rate (83.0 % vs. 36.2 %, p < 0.001). Among functional variables, patients in the HACT3D group exhibited a smaller increase in postoperative serum creatinine (SCR) (7.5 vs. 16.5 μmol/L, p = 0.012), and a smaller decrease in postoperative estimated Glomerular Filtration Rate (eGFR) (-6.9 vs. -14.1 mL/min/1.73 m, p = 0.011). No significant differences were found in pathological outcomes and prognosis between the two groups (p > 0.05).

Conclusions: For completely endophytic RCC patients, HACT3D reconstruction can assist clinicians in performing precise parameter measurements, designing personalized surgical approaches, and providing intraoperative image guidance.