Impact of Three-Dimensional Reconstruction on Surgical Planning in Moderate- and High-Complexity Kidney Cancer: A Pre- and Post-Intervention Study

Background: Nephron-sparing surgery poses challenges in surgical planning, especially for larger or more complex tumors.Objectives: To evaluate the impact of Three-Dimensional (3D) reconstructions on 1) surgical planning (primary outcome) and 2) understanding of renal anatomy (secondary outcome) in moderate-and high-complexity kidney tumors. Methods and Participants:This pr-and post-intervention study included patients who underwent partial or radical nephrectomy between 2018 and 2023.Three-dimensional images achieved from contrast-enhanced Computed Tomography (CT) scans were interpreted by a radiologist and randomly reviewed by 18 blinded urologists specialized in nephron-sparing surgery (Reference and Case group, based on case volume).Outcomes were assessed through questionnaires before the intervention (2D images) and 4-5 weeks later, with the 3D reconstruction.Results: Fourteen patients (57% female and 43% male) with moderate-and high-complexity lesions (R.E.N.A.L. score > 7) were included.Case and Reference groups presented similar experiences and frequency of opinion change.Urologists altered their opinions more frequently following 3D reconstruction, mainly in high-complexity cases.3D reconstruction enhanced urologists' understanding of renal anatomy, increasing selective clamping use and decreasing reliance on intraoperative Ultrasound (USG) and hemostatic agents (p < 0.05) in surgical planning. Conclusions:Our findings suggest that incorporating 3D reconstruction into clinical practice can enhance the understanding of renal anatomy, optimize surgical planning, and promote a nephron-sparing approach.