SRS356 - Multi-visceral resection including en-bloc nephrectomy in sarcoma surgery: renal assessment strategies in a quaternary centre

Abstract Background Multi-visceral resection (MVR) for retroperitoneal sarcoma (RPS) often includes en-bloc nephrectomy.Split renal function (SRF) is traditionally assessed pre-operatively using dimercaptosuccinic acid (DMSA) scans to evaluate the ipsilateral kidneys contribution and the remaining kidney's function post-surgery.Given limited evidence supporting DMSA's utility, we retrospectively evaluated its impact on surgical planning. Methods This retrospective cohort study at Birmingham Sarcoma Service,Queen Elizabeth Hospital, included 217 patients referred for DMSA imaging between 2010 and 2024.DMSA SRF was correlated with other imaging, comorbidities, renal tests, and clinical decisions.A significant SRF difference (≥10%) was the study’s threshold.Statistical analysis incorporated one-way ANOVA with Tukey’s post-hoc test (P < 0.05).Ethics approval was obtained per local governance. Results Of 217 patients, 47 (22%) did not undergo surgery, five were excluded due to insufficient data. Among 165 patients who underwent en-bloc MVR, 19 (12%) had a contralateral SRF ≤45% (SRFD ≥ 10%), with the lowest at 28% (SRFD:44%).Post-operatively, eGFR significantly declined from 77.1 to 63.9 (P < 0.05) but slightly improved after 3–5 years to 65.5 (P = 0.647). Unfavourable DMSA SRF was not a factor in those not progressing to MVR, pre-operative death (30%) and inoperable RPS (21%) were the primary reasons.Poor DMSA results were cited in two clinic letters; yet patient death and consent refusal the respective reasons for no surgery.Finally, one patient required dialysis after bilateral nephrectomy, while four underwent MVR despite incalculable SRF due to tumour-dependent kidney displacement. Conclusions Pre-operative DMSA had minimal impact on MVR decision-making for RPS, suggesting it may not be a necessary resource in surgical planning.