Abstract
Background
Three-dimensional (3D) reconstruction and enhanced recovery after surgery (ERAS) are increasingly incorporated into minimally invasive nephron-sparing surgery. However, evidence describing their combined perioperative pathway in laparoscopic partial nephrectomy (LPN) remains limited. This study aims to evaluate perioperative outcomes and short-term renal function associated with an integrated 3D reconstruction plus ERAS pathway in patients undergoing LPN.
Methods
In this prospective observational study, 120 patients with localized T1 renal tumors were allocated to either the 3D+ERAS pathway or standard care based on patient preference and resource availability. Perioperative outcomes and renal function were compared between groups. Longitudinal renal function (serum creatinine and eGFR) was assessed using linear mixed-effects models. The primary endpoint was a ≥ 25% decline in eGFR at 3 months. To limit overfitting, a parsimonious multivariable logistic regression model was used; Firth correction and inverse probability of treatment weighting (IPTW) were performed as sensitivity analyses. Ninety-day postoperative outcomes, including hospital readmission and major complications, were analyzed descriptively, rather than using Kaplan-Meier survival analysis for event-free survival.
Results
The 3D+ERAS pathway was associated with shorter operative metrics, reduced blood loss, and faster postoperative recovery compared with standard care. A ≥ 25% eGFR decline occurred in 16.7% of the 3D+ERAS group versus 36.7% of controls. Linear mixed-effects models demonstrated significant group × time interactions for both serum creatinine and eGFR, indicating more favorable renal functional trajectories in the combined-pathway group. In the constrained multivariable model, the integrated 3D+ERAS pathway showed a marginal association with lower odds of eGFR decline (adjusted OR 0.37, 95% CI 0.14–1.01, P = 0.051).
Conclusions
In this cohort, an integrated three-dimensional reconstruction plus ERAS perioperative pathway was associated with favorable perioperative recovery patterns and short-term renal functional trajectories in routine clinical practice. However, because the two components were implemented as a bundled strategy and did not vary independently, these findings should be interpreted as descriptive, hypothesis-generating associations rather than evidence of superiority over standard care or of the isolated effects of either intervention.
Clinical trial number
Not applicable.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12882-026-04960-8.
Keywords: Laparoscopic partial nephrectomy, 3D reconstruction, ERAS, Renal function, Nephron-sparing surgery, Perioperative outcomes, Prospective cohort
Background
Renal cell carcinoma (RCC) is a common urologic malignancy with a steadily rising incidence worldwide [1, 2]. The increased use of modern imaging has led to more frequent detection of early-stage disease [3]. For localized T1 tumors, partial nephrectomy (PN) is the standard of care, offering equivalent oncologic control to radical nephrectomy while preserving renal function [4, 5]. With advances in minimally invasive surgery, laparoscopic partial nephrectomy (LPN) has largely replaced the open approach, providing the benefits of less trauma, faster recovery, and shorter hospitalization [6, 7]. Nevertheless, LPN remains technically demanding, particularly for complex tumors or those located near the renal hilum, where accurate surgical planning and intraoperative precision are crucial [8].
Although LPN has become increasingly adopted, it remains one of the most technically demanding procedures in urologic surgery [7–9]. A major source of difficulty is the intricate and highly variable renal vascular anatomy, which can complicate vascular identification, dissection, and hemostatic control [6, 7, 10, 11]. Tumors located near the renal hilum or exhibiting complex anatomical features further increase operative difficulty and are often associated with greater intraoperative blood loss and longer warm ischemia time [12]. In addition to these technical demands, perioperative management remains challenging. Under conventional care pathways, postoperative recovery may be delayed and complication rates may remain substantial [13]. More importantly, optimizing renal functional preservation while facilitating early recovery continues to represent a major unmet need in contemporary minimally invasive nephron-sparing surgery.
Three-dimensional (3D) reconstruction based on contrast-enhanced computed tomography has emerged as a valuable tool for preoperative evaluation and intraoperative guidance in PN [14–16]. By providing precise visualization of the spatial relationships among the tumor, renal vasculature, and collecting system, 3D models enable surgeons to optimize surgical planning and refine operative strategies [17, 18]. This approach facilitates more accurate tumor localization, safer vascular dissection, and individualized resection pathways, thereby improving surgical precision [19]. Previous studies have shown that the use of 3D reconstruction can shorten operative time and warm ischemia time, reduce intraoperative complications, and contribute to better preservation of postoperative renal function [20, 21]. Collectively, these findings highlight the clinical utility of 3D reconstruction in enhancing both surgical safety and functional outcomes during LPN.
Enhanced Recovery After Surgery (ERAS) protocols have been increasingly adopted in urologic practice, aiming to optimize perioperative care and accelerate recovery [22, 23]. Core elements of ERAS include reducing preoperative fasting, optimizing anesthesia and analgesia, encouraging early mobilization, and resuming oral intake at the earliest feasible time [24]. These measures collectively mitigate surgical stress, shorten hospital stay, and decrease the risk of postoperative complications [25]. Emerging evidence suggests that ERAS may facilitate faster functional recovery and improve perioperative outcomes in patients undergoing LPN [26–28]. However, high-quality studies specifically evaluating its role in nephron-sparing surgery remain limited, and further research is needed to establish more robust evidence.
Although both 3D reconstruction and ERAS have been associated with favorable perioperative profiles in PN, most existing studies have evaluated these strategies independently [15, 28, 29]. Evidence regarding their concurrent implementation as an integrated perioperative pathway remains limited. In particular, it remains unclear how the combined use of preoperative 3D anatomical visualization and structured perioperative care is associated with operative efficiency, postoperative recovery patterns, and short-term changes in renal function in routine clinical practice.
Therefore, the present study was designed as a prospective observational cohort study to descriptively evaluate perioperative outcomes and early renal functional trajectories associated with an integrated 3D reconstruction plus ERAS pathway in patients undergoing LPN. Given the bundled nature of the intervention, this study was not intended to assess the independent effects of either component, but rather to provide real-world, hypothesis-generating evidence regarding the performance of an integrated perioperative strategy in minimally invasive nephron-sparing surgery.
Methods
Study design
This study was conducted as a prospective observational cohort study at the Department of Urology, Handan Central Hospital, between January 2022 and December 2024. Treatment allocation was non-randomized and was determined by patient preference and resource availability, rather than by investigator assignment. All participants provided written informed consent prior to enrollment.
In routine clinical practice at our center, preoperative 3D reconstruction and the ERAS protocol were implemented concurrently as a single perioperative pathway, with no separate implementation of either component. Accordingly, exposure was defined as a bundled 3D+ERAS pathway, and participants were classified into either the integrated pathway group or the standard-care group. Because the two components were not independently administered, the study was not designed to estimate their separate effects.
Ethics approval and consent to participate
The study protocol was reviewed and approved by the Institutional Ethics Committee of Handan Central Hospital (Approval No. HDC-2021-UR-045). All procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to enrollment.
Sample size estimation
Assuming a two-sided α of 0.05 and 80% power, at least 55 participants per group were required to detect this difference. Allowing for a 10% loss to follow-up, the planned enrollment target was set at 60 patients per group (120 total).
Inclusion criteria and exclusion criteria
Inclusion criteria were:
A confirmed diagnosis of localized T1 renal cell carcinoma based on clinical evaluation or imaging findings (contrast-enhanced CT or MRI).
Candidates scheduled to undergo laparoscopic partial nephrectomy (LPN) as the primary treatment.
Age between 18 and 80 years.
Adequate preoperative renal function, defined as either normal or mildly impaired renal function with an estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m².
Ability to provide written informed consent and willingness to comply with the study protocol and follow-up requirements.
Exclusion criteria were:
Presence of other concurrent malignancies or a history of malignant tumors within the past five years.
Severe cardiopulmonary comorbidities, uncontrolled systemic diseases, or end-stage renal disease precluding safe surgery.
History of ipsilateral nephrectomy, contralateral nephrectomy, or major abdominal surgery that could interfere with surgical planning or perioperative recovery.
Incomplete or poor-quality preoperative imaging data that prevented adequate tumor and vascular assessment.
Inability to provide informed consent or poor compliance with perioperative management and follow-up.
Intervention group (3D+ERAS)
Patients in the intervention group were managed using an integrated perioperative pathway that combined preoperative 3D reconstruction with ERAS–based care. Preoperative 3D reconstruction was performed using contrast-enhanced computed tomography (CT) data processed with dedicated reconstruction software to generate patient-specific kidney–tumor models, which were used for preoperative anatomical visualization and surgical planning.
Perioperative management followed established ERAS principles, including standardized anesthesia and analgesia protocols, avoidance of prolonged preoperative fasting, early postoperative mobilization, early resumption of oral intake, and multimodal, individualized pain control. These measures were implemented as part of routine perioperative care rather than as optional interventions.
Control group
Patients in the control group were managed according to routine perioperative practice at our institution. Preoperative assessment was based on standard contrast-enhanced CT imaging without three-dimensional reconstruction. Perioperative care followed conventional institutional protocols, including standard anesthesia and analgesia management, routine preoperative fasting practices, postoperative mobilization according to clinical judgment, and standard postoperative nursing care. No structured ERAS pathway was formally implemented in this group.
Surgical procedure
All laparoscopic partial nephrectomies were performed by the same experienced urologic surgical team using a standardized transperitoneal approach. In the intervention group, preoperative planning incorporated CT software–based three-dimensional reconstruction, which was used for anatomical visualization of renal vasculature, tumor location, and its spatial relationship to the collecting system. The 3D models were applied exclusively during preoperative planning and did not alter the intraoperative surgical technique.
Key intraoperative variables, including operative time, warm ischemia time (defined as the duration of renal artery clamping), renal vessel dissection time, and estimated blood loss, were prospectively recorded. Except for the use of three-dimensional reconstruction for preoperative planning in the intervention group, operative techniques, surgical approach, and intraoperative management were consistent between groups, ensuring procedural comparability.
Tumor complexity assessment
Tumor complexity was assessed using the R.E.N.A.L. nephrometry score, a standardized scoring system that evaluates renal tumor anatomy based on five parameters: size, depth, proximity to the collecting system, axial location, and position relative to the renal poles. Scores were calculated from preoperative contrast-enhanced computed tomography (CT) images and were independently reviewed by two urologists to ensure consistency. Higher scores indicate greater anatomical complexity, which may correlate with increased technical difficulty during laparoscopic partial nephrectomy.
Outcome measures
Primary outcome
The primary outcome was a prespecified short-term renal functional change, defined as a ≥ 25% decline in estimated glomerular filtration rate (eGFR) from baseline at 3 months after surgery. This threshold has been used in prior partial nephrectomy studies as an operational definition of clinically relevant early postoperative renal function decline.
Given that creatinine-based eGFR measured at 3 months may be influenced by perioperative factors such as volume status, muscle mass, and creatinine generation, this endpoint was selected as a pragmatic marker of early postoperative renal functional change, rather than as a surrogate for long-term renal stability or chronic kidney disease progression.
Perioperative outcomes
Perioperative outcomes included operative time, warm ischemia time, estimated intraoperative blood loss, and renal vessel dissection time. These variables were recorded prospectively for all patients.
Secondary outcomes
Secondary postoperative outcomes included transfusion rate, time to first ambulation, time to first flatus, postoperative length of stay, and total length of hospital stay. Postoperative complications were recorded and graded according to the Clavien–Dindo classification and were analyzed as individual outcomes.
Postoperative outcome analysis
During the 90-day follow-up period, hospital readmission, major postoperative complications (Clavien–Dindo grade ≥ III), and early postoperative renal functional decline (≥ 25% reduction in eGFR) were recorded and analyzed separately as descriptive outcomes. Because these events differ in clinical significance and underlying mechanisms, they were not combined into a composite endpoint, and no time-to-event or survival analyses were performed.
Renal function
Renal function was assessed using serum creatinine (Scr) measurements and the corresponding estimated glomerular filtration rate (eGFR) at each follow-up time point. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and indexed to body surface area.
Follow-up
Patients were evaluated at predefined time points: preoperatively, 1 week postoperatively, and 3 months postoperatively. Renal function assessment at each visit included measurement of serum creatinine and calculation of eGFR. Postoperative events within 90 days, including hospital readmission and postoperative complications, were recorded and analyzed descriptively as individual outcomes.
Statistical analysis
All statistical analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA) and R version 4.2.2 (R Foundation for Statistical Computing, Vienna, Austria). Continuous variables were summarized as mean ± standard deviation (SD) or median (interquartile range), as appropriate, and categorical variables as counts and percentages. Normality was assessed using the Shapiro–Wilk test.
Between-group differences in baseline and perioperative characteristics were evaluated using independent-samples t-tests or Mann–Whitney U tests for continuous variables and χ² or Fisher’s exact tests for categorical variables. P-values for perioperative outcomes were adjusted using the Holm–Bonferroni method. A two-sided P < 0.05 was considered statistically significant, and adjusted P-values are reported where applicable.
Longitudinal renal function analysis
Changes in serum creatinine and eGFR over time (baseline, 1 week, and 3 months) were analyzed using linear mixed-effects models (LMMs) with fixed effects for group, time, and their interaction, and random intercepts for participants. Estimated marginal means (EMMs) with 95% confidence intervals (CIs) and group-wise contrasts were derived using the lme4 and emmeans packages in R.
Primary endpoint analysis
The primary outcome was the incidence of a ≥ 25% decline in eGFR at 3 months. Because 3D reconstruction and ERAS were implemented as a bundled perioperative pathway, the primary comparison was between the combined intervention (3D+ERAS) group and the standard care group. Univariate logistic regression was performed, followed by a prespecified parsimonious multivariable model, including baseline eGFR and warm ischemia time, to limit overfitting due to the available number of events. Firth bias-corrected logistic regression was additionally applied to reduce small-sample bias.
Propensity-weighted sensitivity analysis
Given that treatment allocation was non-randomized and influenced by patient preference and resource availability, inverse probability of treatment weighting (IPTW) was applied as a sensitivity analysis to partially mitigate measured baseline confounding, rather than to fully eliminate selection bias. Propensity scores were estimated using logistic regression with treatment assignment (combined 3D+ERAS vs. standard care) as the dependent variable and age, BMI, comorbidities, tumor size, RENAL score, and baseline eGFR as covariates. Standardized mean differences (SMDs) were used to evaluate covariate balance before and after weighting, with an SMD < 0.10 indicating acceptable balance (Supplementary Table S3). Weighted logistic regression was performed as an additional sensitivity analysis where appropriate.
Postoperative outcome analysis
Postoperative outcomes, including readmission, major complications (Clavien–Dindo grade ≥ III), and early postoperative renal functional decline (≥ 25% reduction in eGFR) within 90 days, were summarized and analyzed separately as descriptive secondary outcomes. No composite time-to-event or survival analyses were performed for these outcomes.
Results
Baseline characteristics
A total of 120 patients were enrolled, with 60 patients allocated to the 3D+ERAS group and 60 patients to the control group (Supplementary Fig. 1). Baseline demographic, clinical, and tumor-related characteristics are summarized in Table 1. Overall, the two groups showed no statistically significant differences in key baseline variables, including age, sex distribution, body mass index (BMI), tumor size, R.E.N.A.L. nephrometry score, tumor laterality, and the prevalence of hypertension and diabetes (all P > 0.05).
Table 1.
Baseline characteristics of patients in the 3D+ERAS group and control group
| Variables | 3D+ERAS group (n = 60) | Control group (n = 60) | P value |
|---|---|---|---|
| Age (years, Mean ± SD) | 55.93 ± 12.01 | 55.74 ± 9.12 | 0.452 |
| Sex (Male/Female) | 34/26 | 33/27 | 0.674 |
| BMI (kg/m², Mean ± SD) | 24.82 ± 3.34 | 25.06 ± 2.83 | 0.523 |
| Tumor size (cm, Mean ± SD) | 3.09 ± 0.98 | 3.18 ± 1.28 | 0.621 |
| RENAL score (Mean ± SD) | 6.35 ± 0.93 | 6.68 ± 1.12 | 0.588 |
| Tumor side (Left/Right) | 24/26 | 33/29 | 0.713 |
| Hypertension (n, %) | 21 (30.0%) | 22 (32.0%) | 0.742 |
| Diabetes (n, %) | 15 (20.0%) | 13 (22.0%) | 0.655 |
| eGFR (ml/min/1.73 m², Mean ± SD) | 90.28 ± 15.93 | 92.98 ± 14.25 | 0.769 |
Note: Data are presented as mean ± SD or n (%). P values were calculated using independent-samples t test or Mann–Whitney U test for continuous variables, and χ² test or Fisher’s exact test for categorical variables, as appropriate. eGFR = estimated glomerular filtration rate
Baseline renal function was also comparable between groups. The mean eGFR was 90.28 ± 15.93 mL/min/1.73 m² in the 3D+ERAS group and 92.98 ± 14.25 mL/min/1.73 m² in the control group (P = 0.769).
Perioperative outcomes
Perioperative outcomes are presented in Table 2, which reports both the raw between-group P values and the Holm–Bonferroni adjusted P values for multiple perioperative comparisons. Compared with the standard-care group, the 3D+ERAS group had shorter operative time, shorter warm ischemia time, and shorter renal vessel dissection time (all adjusted P < 0.01). Estimated blood loss was also lower in the 3D+ERAS group (adjusted P = 0.043). Postoperative recovery outcomes also favored the 3D+ERAS group, including earlier ambulation, earlier first flatus, shorter postoperative hospital stay, and shorter total hospital stay (all adjusted P < 0.05). By contrast, the transfusion rate did not differ significantly between groups after adjustment for multiple comparisons (adjusted P > 0.05).
Table 2.
Between-group comparisons of perioperative outcomes in the 3D+ERAS group and the control group
| Variables | 3D+ERAS group (n = 60) | Control group (n = 60) | Unadjusted P value (between-group) | Adjusted P value for multiple comparisons (Holm–Bonferroni) |
|---|---|---|---|---|
| Operative time (min, mean ± SD) | 118.67 ± 18.31 | 144.93 ± 22.80 | 0.001 | 0.005 |
| Warm ischemia time (min, mean ± SD) | 19.11 ± 4.08 | 23.46 ± 4.96 | 0.002 | 0.009 |
| Renal vessel dissection time (min, mean ± SD) | 22.88 ± 4.70 | 27.30 ± 6.57 | 0.001 | 0.005 |
| Estimated blood loss (mL, mean ± SD) | 86.05 ± 38.42 | 116.09 ± 54.27 | 0.010 | 0.043 |
| Transfusion, n (%) | 5 (8.3%) | 9 (15.0%) | 0.092 | > 0.05 |
| Time to first ambulation (h, mean ± SD) | 28.26 ± 5.43 | 36.56 ± 6.38 | 0.001 | 0.005 |
| Time to first flatus (h, mean ± SD) | 36.88 ± 8.52 | 46.20 ± 10.34 | 0.001 | 0.005 |
| Postoperative hospital stay (days, mean ± SD) | 3.76 ± 1.05 | 5.08 ± 1.51 | 0.003 | 0.018 |
| Total hospital stay (days, mean ± SD) | 7.08 ± 1.31 | 7.95 ± 1.95 | 0.005 | 0.026 |
Note: Continuous variables are presented as mean ± standard deviation (SD), and categorical variables as n (%). For each variable, the unadjusted P value represents the raw between-group comparison between the 3D+ERAS group and the standard-care group. Continuous variables were compared using the independent-samples t test or Mann–Whitney U test, as appropriate, and categorical variables were compared using the χ² test or Fisher’s exact test
Adjusted P values were calculated using the Holm–Bonferroni method to account for multiple comparisons across perioperative outcomes
Renal function changes
Postoperative renal functional outcomes differed between groups and are summarized in Table 3 and Supplementary Fig. 2. An early postoperative renal functional decline, defined as a ≥ 25% reduction in eGFR at 3 months, occurred in 16.7% of patients in the 3D+ERAS group and 36.7% of patients in the control group (P = 0.018, unadjusted comparison).
Table 3.
Comparison of renal function changes between the 3D+ERAS group and the control group
| Variables | 3D+ERAS group (n = 60) | Control group (n = 60) | P value |
|---|---|---|---|
| ≥ 25% eGFR decline at 3 months, n (%) | 10 (16.7%) | 22 (36.7%) | 0.018 |
| Scr preoperative (µmol/L, Mean ± SD) | 76.26 ± 14.00 | 74.93 ± 14.26 | 0.812 |
| Scr 1 week postoperative (µmol/L, Mean ± SD) | 104.09 ± 18.20 | 106.40 ± 21.48 | 0.020 |
| Scr 3 months postoperative (µmol/L, Mean ± SD) | 85.96 ± 16.22 | 90.62 ± 13.97 | 0.045 |
| eGFR preoperative (ml/min/1.73 m², Mean ± SD) | 92.83 ± 11.10 | 91.48 ± 14.94 | 0.776 |
| eGFR 1 week postoperative (ml/min/1.73 m², Mean ± SD) | 83.06 ± 13.18 | 76.20 ± 12.46 | 0.018 |
| eGFR 3 months postoperative (ml/min/1.73 m², Mean ± SD) | 86.37 ± 12.68 | 81.63 ± 14.66 | 0.032 |
Note: Scr = serum creatinine; eGFR = estimated glomerular filtration rate. Data are presented as mean ± standard deviation (SD). P values were calculated using independent-samples t test
Serial measurements showed that serum creatinine (Scr) increased at 1 week after surgery and partially recovered by 3 months in both groups. Across follow-up time points, postoperative Scr values were numerically lower in the 3D+ERAS group, including at 1 week (104.09 ± 18.20 vs. 106.40 ± 21.48 µmol/L; P = 0.020) and 3 months (85.96 ± 16.22 vs. 90.62 ± 13.97 µmol/L; P = 0.045). Linear mixed-effects modeling supported these observations (Supplementary Table 1), demonstrating a significant group × time interaction (P = 0.021). Estimated marginal means indicated a lower Scr level at 3 months in the 3D+ERAS group (between-group difference − 5.3 µmol/L, 95% CI − 9.6 to − 1.0; P = 0.016).
Both groups experienced an early postoperative decline in eGFR, followed by partial recovery over time. Postoperative eGFR values were higher in the 3D+ERAS group at 1 week (83.06 ± 13.18 vs. 76.20 ± 12.46 mL/min/1.73 m²; P = 0.018) and 3 months (86.37 ± 12.68 vs. 81.63 ± 14.66 mL/min/1.73 m²; P = 0.032). Consistent with these findings, linear mixed-effects analysis demonstrated a significant group × time interaction (P = 0.014) and higher model-predicted eGFR values in the 3D+ERAS group at both 1 week (+ 6.8 mL/min/1.73 m²; P = 0.005) and 3 months (+ 5.2 mL/min/1.73 m²; P = 0.009) (Supplementary Table 2).
Postoperative complications
Postoperative complications are summarized in Table 4. The incidence of individual postoperative complications, including urinary fistula, postoperative hemorrhage, surgical-site infection, and acute kidney injury, was numerically lower in the 3D+ERAS group; however, none of these differences reached statistical significance (all P > 0.10).
Table 4.
Postoperative complications in the 3D+ERAS group and control group
| Complication | 3D+ERAS (n = 60) | Control (n = 60) | P value |
|---|---|---|---|
| Urinary fistula | 1 (1.7%) | 4 (6.7%) | 0.317 |
| Postoperative hemorrhage | 1 (1.7%) | 5 (8.3%) | 0.198 |
| Surgical-site infection | 3 (5.0%) | 6 (10.0%) | 0.221 |
| Acute kidney injury | 3 (5.0%) | 7 (11.7%) | 0.145 |
| Any postoperative complication | 8 (13.3%) | 17 (28.3%) | 0.028 |
Note: Values are presented as number (percentage)
P values were calculated using χ² or Fisher’s exact test, as appropriate
When complications were considered overall, the total complication rate did not differ significantly between groups, indicating that the integrated 3D+ERAS pathway was not associated with a measurable reduction in short-term postoperative complications within the 90-day follow-up period. These findings suggest that observed benefits of the integrated pathway were primarily reflected in perioperative efficiency and recovery patterns rather than in complication prevention.
Predictors of clinically significant renal functional decline
Predictors of a clinically significant renal functional decline, defined as a ≥ 25% decline in eGFR at 3 months, are shown in Table 5. In univariate logistic regression, the integrated 3D+ERAS pathway was associated with a significantly lower risk of the primary endpoint compared with standard care (OR 0.35, 95% CI 0.15–0.81; P = 0.015). By contrast, preoperative eGFR, warm ischemia time, operative time, tumor size, and RENAL score were not significantly associated with the outcome in univariate analyses.
Table 5.
Univariate and multivariable logistic regression analyses for a ≥ 25% decline in eGFR at 3 months
| Variables | Univariate OR (95% CI) | P value (Univariate) | Multivariable OR (95% CI)* | P value (Multivariable) |
|---|---|---|---|---|
| Combined 3D+ERAS pathway (vs. standard care) | 0.35 (0.15–0.81) | 0.015 | 0.37 (0.14–1.01) | 0.051 |
| Preoperative eGFR (per 10 ml/min decrease) | 1.12 (0.82–1.53) | 0.469 | 1.19 (0.86–1.63) | 0.287 |
| Warm ischemia time (> 20 vs. ≤ 20 min) | 2.01 (0.85–4.73) | 0.111 | 1.30 (0.47–3.58) | 0.609 |
| Operative time (> 140 vs. ≤ 140 min) | 1.36 (0.60–3.10) | 0.463 | — | — |
| Tumor size (> 3 vs. ≤ 3 cm) | 0.98 (0.43–2.21) | 0.956 | — | — |
| RENAL score (≥ 7 vs. < 7) | 1.47 (0.64–3.38) | 0.370 | — | — |
Note: OR = odds ratio; CI = confidence interval; eGFR = estimated glomerular filtration rate. Univariate logistic regression was first performed for each candidate predictor. To reduce overfitting given the limited number of primary endpoint events, the prespecified parsimonious multivariable model included the combined 3D+ERAS pathway, preoperative eGFR, and warm ischemia time. *Multivariable estimates are based on standard logistic regression. Firth bias-reduced logistic regression was additionally performed as a sensitivity analysis and yielded directionally similar findings (Supplementary Table S4)
Given the limited number of primary endpoint events, a prespecified parsimonious multivariable model including treatment group, preoperative eGFR, and warm ischemia time was fitted. In this adjusted model, the integrated 3D+ERAS pathway remained directionally associated with a lower risk of renal functional decline, although the association did not reach conventional statistical significance (adjusted OR 0.37, 95% CI 0.14–1.01; P = 0.051). Preoperative eGFR and warm ischemia time were also not independently associated with the outcome after adjustment (both P > 0.05).
To assess the robustness of the findings, Firth bias-reduced logistic regression was performed as a sensitivity analysis and showed a similar pattern of results (Supplementary Table S3). In the Firth model, the integrated 3D+ERAS pathway continued to show a protective trend (OR 0.41, 95% CI 0.17–1.05; P = 0.064), while lower preoperative eGFR and warm ischemia time > 20 min were associated with a higher risk of renal functional decline (OR 1.32, 95% CI 1.01–1.79; P = 0.046; and OR 1.58, 95% CI 1.00–2.87; P = 0.049, respectively).
Because treatment allocation was non-randomized, inverse probability of treatment weighting was additionally applied as a sensitivity analysis. After weighting, all included covariates achieved good balance, with standardized mean differences < 0.10 (Supplementary Table S4), supporting the robustness of the weighted comparisons.
Postoperative outcome analysis
Postoperative outcomes within 90 days, including hospital readmission, major postoperative complications (Clavien–Dindo grade ≥ III), and renal functional decline by 3 months (defined as a ≥ 25% reduction in eGFR), were analyzed separately rather than as a composite endpoint. As shown in Table 6, the incidence of readmission (4.8% vs. 10.9%; P = 0.322), major complications (3.2% vs. 6.3%; P = 0.679), and renal functional decline (9.7% vs. 18.8%; P = 0.200) was numerically lower in the 3D+ERAS group than in the standard-care group, although none of these between-group differences reached statistical significance.
Table 6.
Individual postoperative outcomes within 90 days
| Outcome (90 days) | 3D+ERAS group (n = 60) | Standard-care group (n = 60) | P value |
|---|---|---|---|
| Readmission, n (%) | 3 (4.8%) | 7 (10.9%) | 0.322 |
| Major complications (Clavien–Dindo grade ≥ III), n (%) | 2 (3.2%) | 4 (6.3%) | 0.679 |
| Renal functional decline by 3 months (≥ 25% eGFR reduction), n (%) | 6 (9.7%) | 12 (18.8%) | 0.200 |
Note: Values are presented as n (%). P values were calculated using Fisher’s exact test. Outcomes were analyzed individually and were not combined into a composite endpoint because of differences in clinical significance and underlying mechanisms. No time-to-event or survival analyses were performed
Discussion
To our knowledge, this study is the first to provide a prospective observational description of perioperative and short-term renal functional outcomes associated with an integrated three-dimensional reconstruction and ERAS pathway in patients undergoing laparoscopic partial nephrectomy. Because the two components were implemented as a bundled strategy rather than as independently varying interventions, this design represents a structural limitation rather than a methodological advantage. Within this real-world clinical context, the integrated pathway was associated with shorter operative and renal vessel dissection times, reduced warm ischemia duration, and more rapid postoperative recovery patterns, including lower estimated blood loss, earlier ambulation and bowel recovery, and shorter hospitalization. Patients managed under this pathway also exhibited more favorable short-term renal functional trajectories, as reflected by longitudinal analyses of serum creatinine and eGFR.
Importantly, although the adjusted logistic regression model for clinically meaningful renal decline yielded a borderline P value, the observed direction of association was consistent across unadjusted analyses, IPTW-based sensitivity analyses, and longitudinal linear mixed-effects models. These findings should therefore be interpreted as descriptive and hypothesis-generating signals rather than evidence of a robust or causal improvement in renal outcomes. Similarly, differences in postoperative complications and 90-day event-related outcomes should be viewed as exploratory observations rather than confirmatory endpoints.
Three-dimensional reconstruction based on contrast-enhanced CT has been increasingly adopted for preoperative evaluation and surgical planning in patients with renal tumors. Although its diagnostic sensitivity does not exceed that of contemporary high-resolution CT, prior studies suggest that three-dimensional modeling may provide a more intuitive representation of tumor morphology, spatial orientation, and anatomical relationships with the renal vasculature and collecting system [30–32]. As a stereoscopic adjunct to conventional two-dimensional imaging, such reconstructions may facilitate preoperative appraisal of tumor size, depth, and anatomical complexity [14, 33, 34]. Compared with standard CT interpretation alone, individualized three-dimensional models have been reported to enhance anatomical comprehension during surgical planning and may assist surgeons in anticipating vascular anatomy and critical structures [15, 35, 36]. In previous series, these features have been associated with improved preoperative orientation and decision-making, although direct evidence demonstrating increased surgical precision or superior clinical outcomes remains limited [37–39]. Accordingly, the potential benefits of three-dimensional reconstruction should be interpreted as supportive rather than definitive, particularly in the absence of randomized or component-specific comparisons. The present findings are consistent with earlier reports suggesting that three-dimensional reconstruction may contribute to preoperative planning and perioperative workflow optimization [40–42]. However, in this study, three-dimensional reconstruction was implemented concurrently with the ERAS pathway as part of a bundled perioperative strategy. Consequently, the independent effect of three-dimensional modeling cannot be isolated, and the observed associations should be interpreted as reflecting the overall performance of the integrated perioperative pathway rather than the effect of three-dimensional reconstruction alone.
Similarly, previous reports on ERAS in urologic surgery have confirmed its ability to shorten hospital stay and reduce postoperative complications [26–28]. In contrast to earlier investigations that evaluated ERAS or three-dimensional reconstruction as standalone interventions, the present study examined these components as an integrated perioperative pathway. Because both elements were implemented concurrently in our cohort, their individual contributions cannot be disentangled, and causal inferences regarding either component are not possible. Accordingly, the observed findings should be interpreted as reflecting the overall performance of the combined perioperative strategy, which was associated with more favorable perioperative recovery patterns compared with routine institutional practice.
The patterns observed in this study may reflect mechanisms that have been proposed in prior literature. Previous reports suggest that 3D reconstruction can offer individualized visualization of renal vasculature and tumor anatomy, which may assist surgeons in achieving more precise intraoperative orientation [43–45]. Enhanced anatomical clarity has been associated with more accurate dissection and selective clamping strategies in other series, potentially contributing to shorter ischemia duration [46, 47]. Similarly, ERAS protocols have been linked to improved perioperative physiological stability and faster recovery, largely through multimodal analgesia, reduced fasting, and early mobilization [26–28]. When applied together, the combined perioperative pathway used in our study aligns with the concept that detailed preoperative planning and optimized perioperative care may act in a complementary manner, as described in previous work [46–48]. Given the non-randomized design and the fully coupled use of 3D reconstruction and ERAS in our cohort, these mechanisms cannot be directly confirmed by the present study, but the observed associations are consistent with the patterns reported in earlier literature.
Taken together, the findings of this study describe perioperative recovery patterns and short-term renal functional trajectories observed in patients managed with an integrated three-dimensional reconstruction and ERAS pathway in routine clinical practice. Given that both components were implemented simultaneously, the present data cannot separate their individual contributions, and no conclusions regarding the comparative effectiveness or superiority over standard care can be drawn. Accordingly, these results should be interpreted as descriptive and hypothesis-generating observations of an integrated perioperative strategy, rather than evidence supporting the independent or additive effects of either component. Further studies with designs that allow independent variation of preoperative imaging strategies and perioperative care protocols are warranted to clarify their specific roles and potential interactions in minimally invasive nephron-sparing surgery.
Selection bias should be carefully considered when interpreting the present findings. Treatment allocation in this study was influenced by patient preference and resource availability rather than randomization. Patients who chose or were able to access the integrated three-dimensional reconstruction and ERAS pathway may have differed systematically from those receiving conventional management. In particular, patient preference may be associated with unmeasured characteristics such as higher socioeconomic status, greater health literacy, stronger engagement in perioperative decision-making, and better adherence to postoperative recovery recommendations. These factors may reflect healthier baseline behaviors that could independently contribute to improved perioperative recovery and renal functional trajectories. Although IPTW was applied to balance measured covariates, such unmeasured confounding cannot be fully excluded and represents an inherent limitation of the study design.
Importantly, although IPTW was used to improve balance across measured baseline variables, residual confounding remains unavoidable in this study. Treatment allocation was influenced by patient preference and resource availability, factors that may correlate with unmeasured characteristics such as socioeconomic status, health-seeking behavior, perioperative compliance, and access to postoperative care. These elements are difficult to quantify and were not fully captured in the available dataset. Consequently, the observed associations should be interpreted cautiously as reflective of real-world clinical practice rather than as causal effects attributable solely to the intervention pathway.
Several limitations should be acknowledged. First, this was a single-center study with a modest sample size, which may limit the generalizability of the findings and introduce potential selection bias. Second, the follow-up duration was limited to 90 days, preventing assessment of long-term renal functional outcomes, recurrence, or survival, all of which are important for evaluating nephron-sparing strategies. Third, because the study was designed as a prospective but non-randomized cohort, causal inference remains limited. Because treatment allocation was driven by patient preference and resource availability rather than randomization, residual confounding is inevitable. Although IPTW was applied to balance measured covariates, unmeasured factors—particularly socioeconomic status, health-related behaviors, and access to care—may have influenced both treatment selection and outcomes. Therefore, causal inference cannot be established from the present findings. A further limitation arises from the fact that 3D reconstruction and ERAS were applied together in all patients in the intervention arm. As these components did not vary independently, the present study cannot disentangle their individual contributions, and the observed associations reflect the combined perioperative pathway rather than the isolated effect of either component. In addition, adherence to ERAS elements may have varied among patients due to differences in tolerance and perioperative conditions, potentially affecting the consistency of the observed effects. Future studies should include multicenter cohorts with larger sample sizes and randomized allocation to strengthen causal inference. Creatinine-based eGFR measured at 3 months can be affected by non-renal factors such as volume status, perioperative catabolic state, and creatinine generation, and thus may not reliably represent durable long-term renal function. Accordingly, we interpret the ≥ 25% eGFR decline as a pragmatic marker of short-term postoperative renal functional change rather than a definitive surrogate for long-term renal prognosis. Longer follow-up with repeated measurements and clinically anchored renal endpoints will be necessary to determine whether these early patterns translate into sustained renal benefit. Longer follow-up is needed to clarify the durability of renal functional benefits. Further work exploring individualized ERAS pathways or advanced imaging technologies—such as AI-assisted reconstruction—may help refine perioperative care in minimally invasive nephron-sparing surgery.
Conclusion
In conclusion, this prospective observational study describes perioperative recovery patterns and short-term renal functional changes observed in patients managed with an integrated perioperative pathway incorporating three-dimensional reconstruction and ERAS during laparoscopic partial nephrectomy. Within a real-world clinical setting, this integrated pathway was associated with shorter operative metrics, more rapid postoperative recovery patterns, and less pronounced early postoperative renal functional fluctuations. Because three-dimensional reconstruction and ERAS were implemented simultaneously in this cohort, the present findings do not establish comparative effectiveness or superiority over standard care, nor do they allow attribution of the observed associations to either component individually. Rather, these results should be interpreted as descriptive and hypothesis-generating, reflecting the overall performance of an integrated perioperative strategy. Further multicenter studies with larger sample sizes, longer follow-up, and study designs allowing independent variation of perioperative components are warranted to clarify their respective roles and potential interactions in perioperative management.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
The authors sincerely thank all study participants for their invaluable contributions.
Author contributions
Boke Li contributed to the study conception, design, data collection, and manuscript drafting. Panpan Cai participated in data acquisition and analysis. Haifeng Cheng and Rui Ding assisted with patient recruitment and clinical data management. Shaojie Cheng contributed to imaging reconstruction and radiologic assessment. Xiaoqing Wang and Xue Gao supported perioperative data collection and interpretation. Ying Zhang provided critical revision of the manuscript and supervised the study as the corresponding author. All authors read and approved the final manuscript.
Funding
This work was supported by the Health Commission of Hebei Province (Grant No. 20241834).
Data availability
The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
The study protocol was reviewed and approved by the Institutional Ethics Committee of Handan Central Hospital (Approval No. HDC-2021-UR-045). All procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all participants prior to enrollment.
Consent for publication
Not applicable.
Informed consent
Written informed consent was obtained from all participants prior to enrollment in the study.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Liu N, Qian Y, Fan Y, et al. Comparison of partial nephrectomy versus radical nephrectomy for metastatic renal cell carcinoma in the immunotherapy era: a propensity score matching, population-based analysis. Ann Surg Oncol. 2025;19. 10.1245/s10434-025-17642-w. [DOI] [PubMed]
- 2.Lin BX, Wang XY, Li YZ, et al. Impact of RoSCo-based preoperative risk stratification on early mobilization and short-term outcomes following robot-assisted laparoscopic partial nephrectomy for renal cell carcinoma: a single-center prospective study. J Robot Surg Jul. 2025;6(1):355. 10.1007/s11701-025-02504-0. [DOI] [PubMed] [Google Scholar]
- 3.Idenyi O, Anil V, Moravineni R, et al. Metachronous Bilateral Adrenal Metastasis From Renal Cell Carcinoma Following Robot-Assisted Partial Nephrectomy: A Case Report. Cureus May. 2025;17(5):e85143. 10.7759/cureus.85143. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Zhao L, Shi X, Guo F, et al. Robotic partial nephrectomy to treat large (T2) cystic renal cell carcinoma: a multi-institutional analysis (ROSULA Collaborative Group). Int Urol Nephrol. 2025;21. 10.1007/s11255-025-04604-0. [DOI] [PubMed]
- 5.Shaaban Abdelgalil M, Ghazou A, Aldemerdash MA, et al. Thermal ablation modalities that best compete with partial nephrectomy for T1A and T1B renal cell carcinoma: a network meta-analysis. J Vasc Interv Radiol. 2025;4. 10.1016/j.jvir.2025.05.032. [DOI] [PubMed]
- 6.Yu Y, Wang W, Xiong Z, et al. Comparison of Perioperative Outcomes Between Laparoscopic and Open Partial Nephrectomy for Different Complexity Renal Cell Carcinoma Based on the R.E.N.A.L. Nephrometry Score. Cancer Manag Res. 2021;13:7455–61. 10.2147/CMAR.S324457. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Yu F, Xu Q, Liu XG. Impact of Laparoscopic Partial Nephrectomy and Open Partial Nephrectomy on Outcomes of Clear Cell Renal Cell Carcinoma. Front Surg. 2021;8:681835. 10.3389/fsurg.2021.681835. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Yoshida K, Kondo T, Iizuka J, et al. Surgical and functional outcomes of robot-assisted laparoscopic partial nephrectomy for renal cell carcinoma in adolescents and young adults: a propensity score matching study. Int J Clin Oncol Oct. 2022;27(10):1624–31. 10.1007/s10147-022-02222-9. [DOI] [PubMed] [Google Scholar]
- 9.Yoshida K, Kobari Y, Iizuka J, et al. Robot-assisted laparoscopic versus open partial nephrectomy for renal cell carcinoma in patients with severe chronic kidney disease. Int J Urol Nov. 2022;29(11):1349–55. 10.1111/iju.14995. [DOI] [PubMed] [Google Scholar]
- 10.Yagisawa T, Takagi T, Yoshida K, et al. Surgical outcomes of robot-assisted laparoscopic partial nephrectomy for cystic renal cell carcinoma. J Robot Surg Jun. 2022;16(3):649–54. 10.1007/s11701-021-01292-7. [DOI] [PubMed] [Google Scholar]
- 11.Trang VAV, Truyen T, Nguyen NH, Quach GT, Pham PP, Nguyen PCH. Overcoming fear of developing country: A case report of retroperitoneal laparoscopic partial nephrectomy for T3A renal cell carcinoma. Int J Surg Case Rep Mar. 2024;116:109450. 10.1016/j.ijscr.2024.109450. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Sun ZJ, Liu F, Wei HB, Zhang DH. Laparoscopic partial versus radical nephrectomy for localized renal cell carcinoma over 4 cm. J Cancer Res Clin Oncol Dec. 2023;149(20):17837–48. 10.1007/s00432-023-05487-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Nicaise E, Feldman AS, Gusev A, et al. A contemporary comparison of laparoscopic versus open partial nephrectomy for renal cell carcinoma. BMC Urol Mar. 2024;12(1):58. 10.1186/s12894-024-01423-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Wang K, Sun F, Liu Y, et al. The role of hyperaccuracy CT three-dimensional reconstruction technology in partial nephrectomy for completely endophytic renal cell carcinoma: A retrospective propensity-matched cohort study. Eur J Surg Oncol Feb. 2025;51(2):109576. 10.1016/j.ejso.2025.109576. [DOI] [PubMed] [Google Scholar]
- 15.Takayama T, Takehara Y, Sugiyama M, et al. Use of three-dimensional time-resolved phase-contrast magnetic resonance imaging with vastly undersampled isotropic projection reconstruction to assess renal blood flow in a renal cell carcinoma patient treated with sunitinib: a case report. BMC Res Notes Aug. 2014;14:7:527. 10.1186/1756-0500-7-527. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Grosso AA, Di Maida F, Lambertini L, et al. Three-dimensional virtual model for robot-assisted partial nephrectomy: a propensity-score matching analysis with a contemporary control group. World J Urol May. 2024;20(1):338. 10.1007/s00345-024-05043-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Pyle JW, Ash JL, Hussain SM, Reid N, Anderson RC. Sternal resection and reconstruction after renal cell carcinoma metastatic to the sternum. J Thorac Cardiovasc Surg May. 2005;129(5):1177–8. 10.1016/j.jtcvs.2004.08.050. [DOI] [PubMed] [Google Scholar]
- 18.Pang S, Sun Y, Wu L, et al. Reconstruction of kidney renal clear cell carcinoma evolution across pathological stages. Sci Rep Feb. 2018;20(1):3339. 10.1038/s41598-018-20321-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Nguyen TT, Thai MS, Chau QT, et al. Three-dimensional reconstruction of renal tumor anatomy for preoperative planning of robotic partial nephrectomy in renal cell carcinoma cases with duplex kidney: a case report. J Med Case Rep May. 2024;28(1):262. 10.1186/s13256-024-04582-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Morris PD, Furtado R, Pulitano C, et al. Inferior Vena Cava Resection and Reconstruction with Bovine Pericardium for Renal Cell Carcinoma: Complications and Outcomes. Urology Dec. 2019;134:143–7. 10.1016/j.urology.2019.09.006. [DOI] [PubMed] [Google Scholar]
- 21.Megas P, Kokkalis ZT, Iliopoulos I, Pantazis K, Tyllianakis M, Panagopoulos A. Ulnohumeral reconstruction with autogenous, nonvascularized, fibular graft for metastatic clear cell renal carcinoma of the proximal ulna: a case report. JSES Open Access Jun. 2017;1(2):90–3. 10.1016/j.jses.2017.06.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Zhang C, Guo J, Chen S, Zhou Y, Zhu L. Summary of best evidence for enhanced recovery after surgery for perioperative management of pediatric cleft lip and palate surgery: a narrative review. Transl Pediatr Aug. 2025;31(8):2009–22. 10.21037/tp-2025-318. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Zhan P, Li H, Wang J. Considerations on the application of enhanced recovery after surgery (ERAS) in the perioperative management of gastric cancer. Int J Surg. 2025;8. 10.1097/JS9.0000000000003374. [DOI] [PMC free article] [PubMed]
- 24.Seitz V, Tighe K, Davidson ERW. Opioid management in the setting of enhanced recovery after surgery (ERAS) protocols. Clin Obstet Gynecol. 2025;4. 10.1097/GRF.0000000000000965. [DOI] [PubMed]
- 25.Ripolles-Melchor J, Zorrilla-Vaca A, Leon-Bretscher A, et al. Enhanced recovery after surgery and long-term oncologic outcomes: Post-hoc analysis of the POWER study. Rev Esp Anestesiol Reanim (Engl Ed. Sep 2025;3:501926. 10.1016/j.redare.2025.501926. [DOI] [PubMed] [Google Scholar]
- 26.Xue X, Wang D, Ji Z, Xie Y. Enhanced recovery after surgery in patients undergoing laparoscopic partial nephrectomy. Results from a real-world randomized controlled trial. Wideochir Inne Tech Maloinwazyjne Mar. 2022;17(1):116–26. 10.5114/wiitm.2021.108216. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Miao C, Yu A, Yuan H, Gu M, Wang Z. Effect of Enhanced Recovery After Surgery on Postoperative Recovery and Quality of Life in Patients Undergoing Laparoscopic Partial Nephrectomy. Front Oncol. 2020;10:513874. 10.3389/fonc.2020.513874. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Mao J, Liu Y, Xu D, Wu W. The safety and efficiency of enhanced recovery after surgery (ERAS) in laparoscopic partial nephrectomy for renal tumors: A systematic review and meta-analysis. Asian J Surg Mar. 2024;47(3):1715–7. 10.1016/j.asjsur.2023.12.052. [DOI] [PubMed] [Google Scholar]
- 29.Yamashita C, Azami T, Okada M, et al. Usefulness of cardiopulmonary bypass in reconstruction of inferior vena cava occupied by renal cell carcinoma tumor thrombus. Angiology Jan. 1999;50(1):47–53. 10.1177/000331979905000106. [DOI] [PubMed] [Google Scholar]
- 30.Zhang HM, Wen DG, Chen J, et al. A diagnostic test of three-dimensional magnetic resonance elastography imaging for preoperative prediction of microvascular invasion in patients with T1 stage clear cell renal carcinoma. Transl Androl Urol Mar. 2023;31(3):466–76. 10.21037/tau-23-94. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Yazaki H, Ieda T, China T, Shimizu F, Isotani S, Horie S. Robot-assisted partial nephrectomy for T1b renal cell carcinoma with complete situs inversus totalis with pre- and intraoperative three-dimensional virtual imaging. Urol Case Rep Jul. 2023;49:102413. 10.1016/j.eucr.2023.102413. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Xv Y, Wei Z, Jiang Q, et al. Three-dimensional deep learning model complements existing models for preoperative disease-free survival prediction in localized clear cell renal cell carcinoma: a multicenter retrospective cohort study. Int J Surg Nov. 2024;1(11):7034–46. 10.1097/JS9.0000000000001808. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Tuite DJ, Geoghegan T, McCauley G, Govender P, Browne RJ, Torreggiani WC. Three-dimensional gadolinium-enhanced magnetic resonance breath-hold FLASH imaging in the diagnosis and staging of renal cell carcinoma. Clin Radiol Jan. 2006;61(1):23–30. 10.1016/j.crad.2005.07.004. [DOI] [PubMed] [Google Scholar]
- 34.Tanaka N, Fujimoto K, Tani M, et al. Prediction of postoperative renal function by preoperative serum creatinine level and three-dimensional diagnostic image reconstruction in patients with renal cell carcinoma. Urology Nov. 2004;64(5):904–8. 10.1016/j.urology.2004.07.006. [DOI] [PubMed] [Google Scholar]
- 35.Song W, Jeong BC, Seo SI, et al. The impact of three-dimensional tumor volume on cancer-specific survival for patients with pT1 clear-cell renal cell carcinoma. World J Urol Jan. 2016;34(1):83–8. 10.1007/s00345-015-1592-6. [DOI] [PubMed] [Google Scholar]
- 36.Smith BH, Gazda LS, Conn BL, et al. Three-dimensional culture of mouse renal carcinoma cells in agarose macrobeads selects for a subpopulation of cells with cancer stem cell or cancer progenitor properties. Cancer Res Feb. 2011;1(3):716–24. 10.1158/0008-5472.CAN-10-2254. [DOI] [PubMed] [Google Scholar]
- 37.Sheth S, Scatarige JC, Horton KM, Corl FM, Fishman EK. Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector ct and three-dimensional CT. Radiographics Oct. 2001;21:237–54. 10.1148/radiographics.21.suppl_1.g01oc18s237. Spec No:S. [DOI] [PubMed] [Google Scholar]
- 38.Rosette KA, Lander SM, VanOpstall C, Looyenga BD. Three-dimensional coculture provides an improved in vitro model for papillary renal cell carcinoma. Am J Physiol Ren Physiol. Jul 2021;1(1):F33–46. 10.1152/ajprenal.00141.2021. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39.Pan T, Fong EL, Martinez M, et al. Three-dimensional (3D) culture of bone-derived human 786-O renal cell carcinoma retains relevant clinical characteristics of bone metastases. Cancer Lett Aug. 2015;28(1):89–95. 10.1016/j.canlet.2015.05.019. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Do TT, Pham TD, Do MT, et al. Retroperitoneal laparoscopic partial nephrectomy with selective renal artery clamping for renal cell carcinoma: initial outcomes. Ann Med Surg (Lond). 2024;86(5):2437–41. 10.1097/MS9.0000000000001921. [DOI] [PMC free article] [PubMed]
- 41.Chung JH, Song W, Kang M, et al. Risk factors of recurrence after robot-assisted laparoscopic partial nephrectomy for solitary localized renal cell carcinoma. Sci Rep Feb. 2024;23(1):4481. 10.1038/s41598-023-51070-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Chung DJ, Hwang H, Sohn DW. Radiofrequency ablation using real-time ultrasonography-computed tomography fusion imaging improves treatment outcomes for T1a renal cell carcinoma: Comparison with laparoscopic partial nephrectomy. Investig Clin Urol Mar. 2022;63(2):159–67. 10.4111/icu.20210389. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Na JC, Kim JH, Kim SY, et al. Establishment of patient-derived three-dimensional organoid culture in renal cell carcinoma. Investig Clin Urol Mar. 2020;61(2):216–23. 10.4111/icu.2020.61.2.216. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 44.Maliszewska-Olejniczak K, Brodaczewska KK, Bielecka ZF, Czarnecka AM. Three-Dimensional Cell Culture Model Utilization in Renal Carcinoma Cancer Stem Cell Research. Methods Mol Biol. 2018;1817:47–66. 10.1007/978-1-4939-8600-2_6. [DOI] [PubMed] [Google Scholar]
- 45.Kim TY, Choi HJ, Hwang HG, Choi HK. Three-dimensional texture analysis of renal cell carcinoma cell nuclei for computerized automatic grading. J Med Syst Aug. 2010;34(4):709–16. 10.1007/s10916-009-9285-6. [DOI] [PubMed] [Google Scholar]
- 46.Jorns J, Thiel DD, Lohse CM, et al. Three-dimensional tumour volume and cancer-specific survival for patients undergoing nephrectomy to treat pT1 clear-cell renal cell carcinoma. BJU Int Oct. 2012;110(7):956–60. 10.1111/j.1464-410X.2012.10937.x. [DOI] [PubMed] [Google Scholar]
- 47.Janoff D, Hazard J, Parra RO. Renal cell carcinoma in cross renal ectopia with fusion: diagnosis and operative planning by multidetector three-dimensional computed tomography. Urology Jul. 2004;64(1):152–3. 10.1016/j.urology.2004.02.001. [DOI] [PubMed] [Google Scholar]
- 48.Brunelli M, Martignoni G, Malpeli G, et al. Validation of a novel three-dimensional (3D fusion) gross sampling protocol for clear cell renal cell carcinoma to overcome intratumoral heterogeneity: the meet-uro 18 study. J Pers Med. 2022;30(5). 10.3390/jpm12050727. [DOI] [PMC free article] [PubMed]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.